|
REMOVE HIP PRESSURE ULCER(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
761P0238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.75 |
| Max. Negotiated Rate |
$1,410.67 |
| Rate for Payer: Aetna Commercial |
$1,410.67
|
| Rate for Payer: Ambetter Exchange |
$961.47
|
| Rate for Payer: Anthem Medicaid |
$681.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$961.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$961.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,153.76
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,352.86
|
| Rate for Payer: Healthspan PPO |
$1,127.96
|
| Rate for Payer: Humana Medicaid |
$681.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,233.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$961.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$695.38
|
| Rate for Payer: Molina Healthcare Passport |
$681.75
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,249.91
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$688.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$961.47
|
|
|
REMOVE HIP PRESSURE ULCER(T
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
761T0238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$799.22 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem Medicaid |
$799.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Humana KY Medicaid |
$799.22
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$807.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$815.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
REMOVE HIP PRESSURE ULCER(T
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
761T0238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.20 |
| Max. Negotiated Rate |
$2,231.04 |
| Rate for Payer: Aetna Commercial |
$1,789.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,812.72
|
| Rate for Payer: Cash Price |
$1,162.00
|
| Rate for Payer: Cigna Commercial |
$1,928.92
|
| Rate for Payer: First Health Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial |
$1,975.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,905.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,715.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,045.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,743.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,859.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,021.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,603.56
|
| Rate for Payer: PHCS Commercial |
$2,231.04
|
| Rate for Payer: United Healthcare All Payer |
$2,045.12
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
76102412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Ambetter Exchange |
$13.89
|
| Rate for Payer: Anthem Medicaid |
$9.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.67
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$20.45
|
| Rate for Payer: Humana Medicaid |
$9.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.48
|
| Rate for Payer: Molina Healthcare Passport |
$9.29
|
| Rate for Payer: Multiplan PHCS |
$117.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$18.06
|
| Rate for Payer: UHCCP Medicaid |
$68.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.89
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
76102412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.10
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
REMOVE IMPACTED EAR WAX UNI
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
76102412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$67.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$67.06
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$67.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
REMOVE IMPACTED EAR WAX UNI(T
|
Facility
|
OP
|
$195.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
761T2412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem Medicaid |
$67.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Humana KY Medicaid |
$67.06
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$67.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
REMOVE IMPACTED EAR WAX UNI(T
|
Facility
|
IP
|
$195.00
|
|
|
Service Code
|
HCPCS 69209
|
| Hospital Charge Code |
761T2412
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$150.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$152.10
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cigna Commercial |
$161.85
|
| Rate for Payer: First Health Commercial |
$185.25
|
| Rate for Payer: Humana Commercial |
$165.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.60
|
| Rate for Payer: Ohio Health Group HMO |
$146.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.55
|
| Rate for Payer: PHCS Commercial |
$187.20
|
| Rate for Payer: United Healthcare All Payer |
$171.60
|
|
|
REMOVE IMPLANT FROM FING HAND
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
76100685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$486.01
|
| Rate for Payer: Ambetter Exchange |
$335.16
|
| Rate for Payer: Anthem Medicaid |
$218.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$335.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$402.19
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Healthspan PPO |
$440.22
|
| Rate for Payer: Humana Medicaid |
$218.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$335.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.91
|
| Rate for Payer: Molina Healthcare Passport |
$218.54
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.71
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$335.16
|
|
|
REMOVE IMPLANT FROM FING HAND
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
76100685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVE IMPLANT FROM FING HAND
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
76100685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVE IMPLANT FROM FING HAN(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 26320
|
| Hospital Charge Code |
761P0685
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$486.01
|
| Rate for Payer: Ambetter Exchange |
$335.16
|
| Rate for Payer: Anthem Medicaid |
$218.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$335.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$402.19
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Healthspan PPO |
$440.22
|
| Rate for Payer: Humana Medicaid |
$218.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$335.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.91
|
| Rate for Payer: Molina Healthcare Passport |
$218.54
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$435.71
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$335.16
|
|
|
REMOVE/INSERT DRUG IMPLANT
|
Professional
|
Both
|
$1,178.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$706.80 |
| Rate for Payer: Aetna Commercial |
$283.95
|
| Rate for Payer: Ambetter Exchange |
$98.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.67
|
| Rate for Payer: Anthem Medicaid |
$162.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.83
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cigna Commercial |
$319.63
|
| Rate for Payer: Healthspan PPO |
$277.12
|
| Rate for Payer: Humana Medicaid |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.60
|
| Rate for Payer: Molina Healthcare Passport |
$162.35
|
| Rate for Payer: Multiplan PHCS |
$706.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.65
|
| Rate for Payer: UHCCP Medicaid |
$109.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.19
|
|
|
REMOVE/INSERT DRUG IMPLANT
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.70 |
| Max. Negotiated Rate |
$1,130.88 |
| Rate for Payer: Aetna Commercial |
$907.06
|
| Rate for Payer: Anthem Medicaid |
$405.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cigna Commercial |
$977.74
|
| Rate for Payer: First Health Commercial |
$1,119.10
|
| Rate for Payer: Humana Commercial |
$1,001.30
|
| Rate for Payer: Humana KY Medicaid |
$405.11
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$409.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$965.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.64
|
| Rate for Payer: Ohio Health Group HMO |
$883.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.82
|
| Rate for Payer: PHCS Commercial |
$1,130.88
|
| Rate for Payer: United Healthcare All Payer |
$1,036.64
|
|
|
REMOVE/INSERT DRUG IMPLANT
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
76100119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.40 |
| Max. Negotiated Rate |
$1,130.88 |
| Rate for Payer: Aetna Commercial |
$907.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.84
|
| Rate for Payer: Cash Price |
$589.00
|
| Rate for Payer: Cigna Commercial |
$977.74
|
| Rate for Payer: First Health Commercial |
$1,119.10
|
| Rate for Payer: Humana Commercial |
$1,001.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$965.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.64
|
| Rate for Payer: Ohio Health Group HMO |
$883.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.82
|
| Rate for Payer: PHCS Commercial |
$1,130.88
|
| Rate for Payer: United Healthcare All Payer |
$1,036.64
|
|
|
REMOVE/INSERT DRUG IMPLANT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
761P0119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$283.95
|
| Rate for Payer: Ambetter Exchange |
$98.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$104.67
|
| Rate for Payer: Anthem Medicaid |
$162.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$117.83
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$319.63
|
| Rate for Payer: Healthspan PPO |
$277.12
|
| Rate for Payer: Humana Medicaid |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.60
|
| Rate for Payer: Molina Healthcare Passport |
$162.35
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.65
|
| Rate for Payer: UHCCP Medicaid |
$109.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.19
|
|
|
REMOVE/INSERT DRUG IMPLANT(T
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
761T0119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$173.40 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.84
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.82
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
REMOVE/INSERT DRUG IMPLANT(T
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS 11983
|
| Hospital Charge Code |
761T0119
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.77 |
| Max. Negotiated Rate |
$554.88 |
| Rate for Payer: Aetna Commercial |
$445.06
|
| Rate for Payer: Anthem Medicaid |
$198.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$450.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cash Price |
$289.00
|
| Rate for Payer: Cigna Commercial |
$479.74
|
| Rate for Payer: First Health Commercial |
$549.10
|
| Rate for Payer: Humana Commercial |
$491.30
|
| Rate for Payer: Humana KY Medicaid |
$198.77
|
| Rate for Payer: Humana Medicare Advantage |
$368.70
|
| Rate for Payer: Kentucky WC Medicaid |
$200.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$473.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$426.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$202.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$508.64
|
| Rate for Payer: Ohio Health Group HMO |
$433.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$462.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.82
|
| Rate for Payer: PHCS Commercial |
$554.88
|
| Rate for Payer: United Healthcare All Payer |
$508.64
|
|
|
REMOVE INTRA-AORTIC BALLOON
|
Professional
|
Both
|
$921.79
|
|
|
Service Code
|
HCPCS 33974
|
| Hospital Charge Code |
76102728
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.63 |
| Max. Negotiated Rate |
$1,538.19 |
| Rate for Payer: Aetna Commercial |
$1,538.19
|
| Rate for Payer: Ambetter Exchange |
$837.15
|
| Rate for Payer: Anthem Medicaid |
$543.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$837.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$837.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,004.58
|
| Rate for Payer: Cash Price |
$460.90
|
| Rate for Payer: Cash Price |
$460.90
|
| Rate for Payer: Cigna Commercial |
$1,440.15
|
| Rate for Payer: Healthspan PPO |
$1,512.34
|
| Rate for Payer: Humana Medicaid |
$543.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,266.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$837.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$837.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$554.48
|
| Rate for Payer: Molina Healthcare Passport |
$543.61
|
| Rate for Payer: Multiplan PHCS |
$553.07
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,088.30
|
| Rate for Payer: UHCCP Medicaid |
$322.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$549.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$837.15
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
761P2766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$1,497.61 |
| Rate for Payer: Ambetter Exchange |
$280.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.82
|
| Rate for Payer: Anthem Medicaid |
$1,303.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$280.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$336.73
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$521.35
|
| Rate for Payer: Healthspan PPO |
$1,497.61
|
| Rate for Payer: Humana Medicaid |
$1,303.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$280.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,329.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,303.87
|
| Rate for Payer: Multiplan PHCS |
$948.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.79
|
| Rate for Payer: UHCCP Medicaid |
$185.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,316.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$280.61
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
76102766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.36 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem Medicaid |
$543.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Humana KY Medicaid |
$543.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$548.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,374.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.20
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
76102766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$474.00 |
| Max. Negotiated Rate |
$1,516.80 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,374.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.20
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
REMOVE INTRVAS FOREIGN BODY
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 37197
|
| Hospital Charge Code |
76102766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$1,497.61 |
| Rate for Payer: Ambetter Exchange |
$280.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$176.82
|
| Rate for Payer: Anthem Medicaid |
$1,303.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$280.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$336.73
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$521.35
|
| Rate for Payer: Healthspan PPO |
$1,497.61
|
| Rate for Payer: Humana Medicaid |
$1,303.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$382.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$280.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,329.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,303.87
|
| Rate for Payer: Multiplan PHCS |
$948.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.79
|
| Rate for Payer: UHCCP Medicaid |
$185.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,316.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$280.61
|
|
|
REMOVE KIDNEY OPEN
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 50220
|
| Hospital Charge Code |
76102893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$772.50 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,060.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,240.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,776.75
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
REMOVE KIDNEY OPEN
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 50220
|
| Hospital Charge Code |
76102893
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$860.66 |
| Max. Negotiated Rate |
$1,668.44 |
| Rate for Payer: Aetna Commercial |
$1,668.44
|
| Rate for Payer: Ambetter Exchange |
$1,001.10
|
| Rate for Payer: Anthem Medicaid |
$860.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,001.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,001.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,201.32
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$1,494.12
|
| Rate for Payer: Healthspan PPO |
$1,334.07
|
| Rate for Payer: Humana Medicaid |
$860.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,419.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,001.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$877.87
|
| Rate for Payer: Molina Healthcare Passport |
$860.66
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,301.43
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$869.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,001.10
|
|
