|
REMOVE KIDNEY OPEN
|
Facility
|
OP
|
$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 Medicaid |
$885.54
|
| 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: Humana KY Medicaid |
$885.54
|
| Rate for Payer: Kentucky WC Medicaid |
$894.55
|
| 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: Molina Healthcare Medicaid |
$903.31
|
| 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 KNEE JOINT LINING
|
Professional
|
Both
|
$1,865.00
|
|
|
Service Code
|
HCPCS 27335
|
| Hospital Charge Code |
76102993
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.91 |
| Max. Negotiated Rate |
$1,233.10 |
| Rate for Payer: Aetna Commercial |
$1,127.54
|
| Rate for Payer: Ambetter Exchange |
$731.01
|
| Rate for Payer: Anthem Medicaid |
$634.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$731.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$731.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.21
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cash Price |
$932.50
|
| Rate for Payer: Cigna Commercial |
$1,233.10
|
| Rate for Payer: Healthspan PPO |
$1,021.31
|
| Rate for Payer: Humana Medicaid |
$634.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$947.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$731.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$731.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$647.61
|
| Rate for Payer: Molina Healthcare Passport |
$634.91
|
| Rate for Payer: Multiplan PHCS |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$950.31
|
| Rate for Payer: UHCCP Medicaid |
$652.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$641.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$731.01
|
|
|
REMOVE LOWER LEG BONE LESION
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
76100903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$962.39 |
| Rate for Payer: Aetna Commercial |
$874.21
|
| Rate for Payer: Ambetter Exchange |
$549.26
|
| Rate for Payer: Anthem Medicaid |
$460.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$549.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$549.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$659.11
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$962.39
|
| Rate for Payer: Healthspan PPO |
$791.85
|
| Rate for Payer: Humana Medicaid |
$460.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$735.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$549.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$469.63
|
| Rate for Payer: Molina Healthcare Passport |
$460.42
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$714.04
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$549.26
|
|
|
REMOVE LOWER LEG BONE LESION
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
76100903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.65 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVE LOWER LEG BONE LESION
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
76100903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REMOVE LOWER LEG BONE LESIO(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 27635
|
| Hospital Charge Code |
761P0903
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$962.39 |
| Rate for Payer: Aetna Commercial |
$874.21
|
| Rate for Payer: Ambetter Exchange |
$549.26
|
| Rate for Payer: Anthem Medicaid |
$460.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$549.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$549.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$659.11
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$962.39
|
| Rate for Payer: Healthspan PPO |
$791.85
|
| Rate for Payer: Humana Medicaid |
$460.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$735.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$549.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$469.63
|
| Rate for Payer: Molina Healthcare Passport |
$460.42
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$714.04
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$465.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$549.26
|
|
|
REMOVE LUNG ARTERY EMBOLI
|
Professional
|
Both
|
$2,675.00
|
|
|
Service Code
|
HCPCS 33910
|
| Hospital Charge Code |
76102761
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$936.25 |
| Max. Negotiated Rate |
$3,180.59 |
| Rate for Payer: Aetna Commercial |
$2,834.80
|
| Rate for Payer: Ambetter Exchange |
$2,446.61
|
| Rate for Payer: Anthem Medicaid |
$1,101.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,446.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,446.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,935.93
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Cash Price |
$1,337.50
|
| Rate for Payer: Cigna Commercial |
$2,618.28
|
| Rate for Payer: Healthspan PPO |
$2,787.17
|
| Rate for Payer: Humana Medicaid |
$1,101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,368.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,446.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,446.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,123.73
|
| Rate for Payer: Molina Healthcare Passport |
$1,101.70
|
| Rate for Payer: Multiplan PHCS |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,180.59
|
| Rate for Payer: UHCCP Medicaid |
$936.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,112.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,446.61
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
IP
|
$2,604.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
76101199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$781.20 |
| Max. Negotiated Rate |
$2,499.84 |
| Rate for Payer: Aetna Commercial |
$2,005.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,031.12
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$2,161.32
|
| Rate for Payer: First Health Commercial |
$2,473.80
|
| Rate for Payer: Humana Commercial |
$2,213.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,135.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,921.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$781.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,291.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,953.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,083.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,796.76
|
| Rate for Payer: PHCS Commercial |
$2,499.84
|
| Rate for Payer: United Healthcare All Payer |
$2,291.52
|
|
|
REMOVE LUNG CATHETER
|
Facility
|
OP
|
$2,604.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
76101199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$2,499.84 |
| Rate for Payer: Aetna Commercial |
$2,005.08
|
| Rate for Payer: Anthem Medicaid |
$895.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,031.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$2,161.32
|
| Rate for Payer: First Health Commercial |
$2,473.80
|
| Rate for Payer: Humana Commercial |
$2,213.40
|
| Rate for Payer: Humana KY Medicaid |
$895.52
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$904.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,135.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,921.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$913.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,291.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,953.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,083.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,265.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,796.76
|
| Rate for Payer: PHCS Commercial |
$2,499.84
|
| Rate for Payer: United Healthcare All Payer |
$2,291.52
|
|
|
REMOVE LUNG CATHETER
|
Professional
|
Both
|
$2,604.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
76101199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.94 |
| Max. Negotiated Rate |
$1,562.40 |
| Rate for Payer: Aetna Commercial |
$275.21
|
| Rate for Payer: Ambetter Exchange |
$146.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.94
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.58
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cash Price |
$1,302.00
|
| Rate for Payer: Cigna Commercial |
$311.71
|
| Rate for Payer: Healthspan PPO |
$189.31
|
| Rate for Payer: Humana Medicaid |
$133.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.10
|
| Rate for Payer: Molina Healthcare Passport |
$133.43
|
| Rate for Payer: Multiplan PHCS |
$1,562.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.22
|
| Rate for Payer: UHCCP Medicaid |
$83.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.32
|
|
|
REMOVE LUNG CATHETER(P
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
761P1199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.94 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$275.21
|
| Rate for Payer: Ambetter Exchange |
$146.32
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.94
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.58
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$311.71
|
| Rate for Payer: Healthspan PPO |
$189.31
|
| Rate for Payer: Humana Medicaid |
$133.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$221.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$146.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.10
|
| Rate for Payer: Molina Healthcare Passport |
$133.43
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$190.22
|
| Rate for Payer: UHCCP Medicaid |
$83.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$134.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.32
|
|
|
REMOVE LUNG CATHETER(T
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
761T1199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
REMOVE LUNG CATHETER(T
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
HCPCS 32552
|
| Hospital Charge Code |
761T1199
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,943.04 |
| Rate for Payer: Aetna Commercial |
$1,558.48
|
| Rate for Payer: Anthem Medicaid |
$696.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$571.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$799.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$771.20
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: First Health Commercial |
$1,922.80
|
| Rate for Payer: Humana Commercial |
$1,720.40
|
| Rate for Payer: Humana KY Medicaid |
$696.05
|
| Rate for Payer: Humana Medicare Advantage |
$571.26
|
| Rate for Payer: Kentucky WC Medicaid |
$703.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,760.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,396.56
|
| Rate for Payer: PHCS Commercial |
$1,943.04
|
| Rate for Payer: United Healthcare All Payer |
$1,781.12
|
|
|
REMOVE LYMPY NODE DEEP
|
Professional
|
Both
|
$7,366.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
76101595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$4,419.60 |
| Rate for Payer: Aetna Commercial |
$613.02
|
| Rate for Payer: Ambetter Exchange |
$397.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.91
|
| Rate for Payer: Anthem Medicaid |
$193.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$397.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$397.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$476.66
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cigna Commercial |
$581.51
|
| Rate for Payer: Healthspan PPO |
$584.31
|
| Rate for Payer: Humana Medicaid |
$193.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$540.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$397.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.37
|
| Rate for Payer: Molina Healthcare Passport |
$193.50
|
| Rate for Payer: Multiplan PHCS |
$4,419.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$516.39
|
| Rate for Payer: UHCCP Medicaid |
$225.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$397.22
|
|
|
REMOVE LYMPY NODE DEEP
|
Facility
|
OP
|
$7,366.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
76101595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,533.17 |
| Max. Negotiated Rate |
$7,071.36 |
| Rate for Payer: Aetna Commercial |
$5,671.82
|
| Rate for Payer: Anthem Medicaid |
$2,533.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,745.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cigna Commercial |
$6,113.78
|
| Rate for Payer: First Health Commercial |
$6,997.70
|
| Rate for Payer: Humana Commercial |
$6,261.10
|
| Rate for Payer: Humana KY Medicaid |
$2,533.17
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,558.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,040.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,436.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,583.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,482.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,524.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,408.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,082.54
|
| Rate for Payer: PHCS Commercial |
$7,071.36
|
| Rate for Payer: United Healthcare All Payer |
$6,482.08
|
|
|
REMOVE LYMPY NODE DEEP
|
Facility
|
IP
|
$7,366.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
76101595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,209.80 |
| Max. Negotiated Rate |
$7,071.36 |
| Rate for Payer: Aetna Commercial |
$5,671.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,745.48
|
| Rate for Payer: Cash Price |
$3,683.00
|
| Rate for Payer: Cigna Commercial |
$6,113.78
|
| Rate for Payer: First Health Commercial |
$6,997.70
|
| Rate for Payer: Humana Commercial |
$6,261.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,040.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,436.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,209.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,482.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,524.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,892.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,408.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,082.54
|
| Rate for Payer: PHCS Commercial |
$7,071.36
|
| Rate for Payer: United Healthcare All Payer |
$6,482.08
|
|
|
REMOVE LYMPY NODE DEEP(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
761P1595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$613.02 |
| Rate for Payer: Aetna Commercial |
$613.02
|
| Rate for Payer: Ambetter Exchange |
$397.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$214.91
|
| Rate for Payer: Anthem Medicaid |
$193.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$397.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$397.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$476.66
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.51
|
| Rate for Payer: Healthspan PPO |
$584.31
|
| Rate for Payer: Humana Medicaid |
$193.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$540.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$397.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$397.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$197.37
|
| Rate for Payer: Molina Healthcare Passport |
$193.50
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$516.39
|
| Rate for Payer: UHCCP Medicaid |
$225.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$195.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$397.22
|
|
|
REMOVE LYMPY NODE DEEP(T
|
Facility
|
IP
|
$6,666.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
761T1595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,999.80 |
| Max. Negotiated Rate |
$6,399.36 |
| Rate for Payer: Aetna Commercial |
$5,132.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,199.48
|
| Rate for Payer: Cash Price |
$3,333.00
|
| Rate for Payer: Cigna Commercial |
$5,532.78
|
| Rate for Payer: First Health Commercial |
$6,332.70
|
| Rate for Payer: Humana Commercial |
$5,666.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,466.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,919.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,999.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,866.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,799.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,599.54
|
| Rate for Payer: PHCS Commercial |
$6,399.36
|
| Rate for Payer: United Healthcare All Payer |
$5,866.08
|
|
|
REMOVE LYMPY NODE DEEP(T
|
Facility
|
OP
|
$6,666.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
761T1595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,292.44 |
| Max. Negotiated Rate |
$6,399.36 |
| Rate for Payer: Aetna Commercial |
$5,132.82
|
| Rate for Payer: Anthem Medicaid |
$2,292.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,199.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$3,333.00
|
| Rate for Payer: Cash Price |
$3,333.00
|
| Rate for Payer: Cigna Commercial |
$5,532.78
|
| Rate for Payer: First Health Commercial |
$6,332.70
|
| Rate for Payer: Humana Commercial |
$5,666.10
|
| Rate for Payer: Humana KY Medicaid |
$2,292.44
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,315.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,466.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,919.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,866.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,999.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,332.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,799.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,599.54
|
| Rate for Payer: PHCS Commercial |
$6,399.36
|
| Rate for Payer: United Healthcare All Payer |
$5,866.08
|
|
|
REMOVE MESH FROM ABD WALL
|
Facility
|
OP
|
$4,295.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
76100022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,288.50 |
| Max. Negotiated Rate |
$4,123.20 |
| Rate for Payer: Aetna Commercial |
$3,307.15
|
| Rate for Payer: Anthem Medicaid |
$1,477.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,350.10
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cigna Commercial |
$3,564.85
|
| Rate for Payer: First Health Commercial |
$4,080.25
|
| Rate for Payer: Humana Commercial |
$3,650.75
|
| Rate for Payer: Humana KY Medicaid |
$1,477.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,492.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,506.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,779.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,963.55
|
| Rate for Payer: PHCS Commercial |
$4,123.20
|
| Rate for Payer: United Healthcare All Payer |
$3,779.60
|
|
|
REMOVE MESH FROM ABD WALL
|
Facility
|
IP
|
$4,295.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
76100022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,288.50 |
| Max. Negotiated Rate |
$4,123.20 |
| Rate for Payer: Aetna Commercial |
$3,307.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,350.10
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cigna Commercial |
$3,564.85
|
| Rate for Payer: First Health Commercial |
$4,080.25
|
| Rate for Payer: Humana Commercial |
$3,650.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,779.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,221.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,736.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,963.55
|
| Rate for Payer: PHCS Commercial |
$4,123.20
|
| Rate for Payer: United Healthcare All Payer |
$3,779.60
|
|
|
REMOVE MESH FROM ABD WALL
|
Professional
|
Both
|
$4,295.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
76100022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.69 |
| Max. Negotiated Rate |
$2,577.00 |
| Rate for Payer: Aetna Commercial |
$415.56
|
| Rate for Payer: Ambetter Exchange |
$258.23
|
| Rate for Payer: Anthem Medicaid |
$215.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.88
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cash Price |
$2,147.50
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Healthspan PPO |
$332.28
|
| Rate for Payer: Humana Medicaid |
$215.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$220.00
|
| Rate for Payer: Molina Healthcare Passport |
$215.69
|
| Rate for Payer: Multiplan PHCS |
$2,577.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.70
|
| Rate for Payer: UHCCP Medicaid |
$1,503.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.23
|
|
|
REMOVE MESH FROM ABD WALL(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
761P0022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$415.56 |
| Rate for Payer: Aetna Commercial |
$415.56
|
| Rate for Payer: Ambetter Exchange |
$258.23
|
| Rate for Payer: Anthem Medicaid |
$215.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.88
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Healthspan PPO |
$332.28
|
| Rate for Payer: Humana Medicaid |
$215.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$258.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$220.00
|
| Rate for Payer: Molina Healthcare Passport |
$215.69
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.70
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.23
|
|
|
REMOVE MESH FROM ABD WALL(T
|
Facility
|
IP
|
$3,745.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
761T0022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,123.50 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$2,883.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,921.10
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cigna Commercial |
$3,108.35
|
| Rate for Payer: First Health Commercial |
$3,557.75
|
| Rate for Payer: Humana Commercial |
$3,183.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,070.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,763.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,295.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,258.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,584.05
|
| Rate for Payer: PHCS Commercial |
$3,595.20
|
| Rate for Payer: United Healthcare All Payer |
$3,295.60
|
|
|
REMOVE MESH FROM ABD WALL(T
|
Facility
|
OP
|
$3,745.00
|
|
|
Service Code
|
HCPCS 11008
|
| Hospital Charge Code |
761T0022
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,123.50 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$2,883.65
|
| Rate for Payer: Anthem Medicaid |
$1,287.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,921.10
|
| Rate for Payer: Cash Price |
$1,872.50
|
| Rate for Payer: Cigna Commercial |
$3,108.35
|
| Rate for Payer: First Health Commercial |
$3,557.75
|
| Rate for Payer: Humana Commercial |
$3,183.25
|
| Rate for Payer: Humana KY Medicaid |
$1,287.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,301.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,070.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,763.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,313.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,295.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,258.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,584.05
|
| Rate for Payer: PHCS Commercial |
$3,595.20
|
| Rate for Payer: United Healthcare All Payer |
$3,295.60
|
|
