|
REMOVE PROSTATE REGROWTH
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
76102114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$980.12 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem Medicaid |
$980.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Humana KY Medicaid |
$980.12
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$990.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$999.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
REMOVE PROSTATE REGROWTH
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
76102114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.76 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna Commercial |
$719.87
|
| Rate for Payer: Ambetter Exchange |
$384.76
|
| Rate for Payer: Anthem Medicaid |
$444.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$384.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$384.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$461.71
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$634.71
|
| Rate for Payer: Healthspan PPO |
$575.60
|
| Rate for Payer: Humana Medicaid |
$444.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$384.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.32
|
| Rate for Payer: Molina Healthcare Passport |
$444.43
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.19
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$384.76
|
|
|
REMOVE PROSTATE REGROWTH
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
76102114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$855.00 |
| Max. Negotiated Rate |
$2,736.00 |
| Rate for Payer: Aetna Commercial |
$2,194.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,223.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$2,365.50
|
| Rate for Payer: First Health Commercial |
$2,707.50
|
| Rate for Payer: Humana Commercial |
$2,422.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,337.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,103.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$855.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,508.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,137.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,479.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,966.50
|
| Rate for Payer: PHCS Commercial |
$2,736.00
|
| Rate for Payer: United Healthcare All Payer |
$2,508.00
|
|
|
REMOVE PROSTATE REGROWTH(P
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 52630
|
| Hospital Charge Code |
761P2114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$384.76 |
| Max. Negotiated Rate |
$1,710.00 |
| Rate for Payer: Aetna Commercial |
$719.87
|
| Rate for Payer: Ambetter Exchange |
$384.76
|
| Rate for Payer: Anthem Medicaid |
$444.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$384.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$384.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$461.71
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cash Price |
$1,425.00
|
| Rate for Payer: Cigna Commercial |
$634.71
|
| Rate for Payer: Healthspan PPO |
$575.60
|
| Rate for Payer: Humana Medicaid |
$444.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$603.86
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$384.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$453.32
|
| Rate for Payer: Molina Healthcare Passport |
$444.43
|
| Rate for Payer: Multiplan PHCS |
$1,710.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$500.19
|
| Rate for Payer: UHCCP Medicaid |
$997.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$384.76
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$581.19 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem Medicaid |
$581.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| 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 |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Humana KY Medicaid |
$581.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$587.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.10
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,014.00 |
| Rate for Payer: Aetna Commercial |
$718.16
|
| Rate for Payer: Ambetter Exchange |
$692.83
|
| Rate for Payer: Anthem Medicaid |
$340.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$831.40
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$793.00
|
| Rate for Payer: Healthspan PPO |
$650.50
|
| Rate for Payer: Humana Medicaid |
$340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.89
|
| Rate for Payer: Molina Healthcare Passport |
$340.09
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.68
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.83
|
|
|
REMOVE RADIUS HEAD IMPLANT
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
76100513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.00 |
| Max. Negotiated Rate |
$1,622.40 |
| Rate for Payer: Aetna Commercial |
$1,301.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.20
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$1,402.70
|
| Rate for Payer: First Health Commercial |
$1,605.50
|
| Rate for Payer: Humana Commercial |
$1,436.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,385.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.10
|
| Rate for Payer: PHCS Commercial |
$1,622.40
|
| Rate for Payer: United Healthcare All Payer |
$1,487.20
|
|
|
REMOVE RADIUS HEAD IMPLANT(P
|
Professional
|
Both
|
$1,690.00
|
|
|
Service Code
|
HCPCS 24164
|
| Hospital Charge Code |
761P0513
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.09 |
| Max. Negotiated Rate |
$1,014.00 |
| Rate for Payer: Aetna Commercial |
$718.16
|
| Rate for Payer: Ambetter Exchange |
$692.83
|
| Rate for Payer: Anthem Medicaid |
$340.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$692.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$831.40
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cash Price |
$845.00
|
| Rate for Payer: Cigna Commercial |
$793.00
|
| Rate for Payer: Healthspan PPO |
$650.50
|
| Rate for Payer: Humana Medicaid |
$340.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$692.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$692.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$346.89
|
| Rate for Payer: Molina Healthcare Passport |
$340.09
|
| Rate for Payer: Multiplan PHCS |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.68
|
| Rate for Payer: UHCCP Medicaid |
$591.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$343.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$692.83
|
|
|
REMOVE RECTAL OBSTRUCTION
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
76101908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$270.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
REMOVE RECTAL OBSTRUCTION
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
76101908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Ambetter Exchange |
$216.94
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$260.33
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Healthspan PPO |
$361.42
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$216.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$282.02
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.94
|
|
|
REMOVE RECTAL OBSTRUCTION
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
76101908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$309.51 |
| Max. Negotiated Rate |
$1,525.23 |
| Rate for Payer: Aetna Commercial |
$693.00
|
| Rate for Payer: Anthem Medicaid |
$309.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,089.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$702.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,525.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,470.76
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$747.00
|
| Rate for Payer: First Health Commercial |
$855.00
|
| Rate for Payer: Humana Commercial |
$765.00
|
| Rate for Payer: Humana KY Medicaid |
$309.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,089.45
|
| Rate for Payer: Kentucky WC Medicaid |
$312.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$738.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$664.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,307.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$792.00
|
| Rate for Payer: Ohio Health Group HMO |
$675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$783.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.00
|
| Rate for Payer: PHCS Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Payer |
$792.00
|
|
|
REMOVE RECTAL OBSTRUCTION(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 45915
|
| Hospital Charge Code |
761P1908
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$540.00 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Ambetter Exchange |
$216.94
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$216.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$216.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$260.33
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$299.36
|
| Rate for Payer: Healthspan PPO |
$361.42
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$216.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$216.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$282.02
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$216.94
|
|
|
REMOVE RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$2,565.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
76102820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.50 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$1,975.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$2,128.95
|
| Rate for Payer: First Health Commercial |
$2,436.75
|
| Rate for Payer: Humana Commercial |
$2,180.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,103.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,892.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$769.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,257.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,923.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,052.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,231.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,769.85
|
| Rate for Payer: PHCS Commercial |
$2,462.40
|
| Rate for Payer: United Healthcare All Payer |
$2,257.20
|
|
|
REMOVE RENAL TUBE W/FLUORO
|
Professional
|
Both
|
$2,565.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
76102820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: Ambetter Exchange |
$50.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.46
|
| Rate for Payer: Anthem Medicaid |
$360.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.29
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$82.26
|
| Rate for Payer: Healthspan PPO |
$405.68
|
| Rate for Payer: Humana Medicaid |
$360.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.76
|
| Rate for Payer: Molina Healthcare Passport |
$360.55
|
| Rate for Payer: Multiplan PHCS |
$1,539.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.31
|
| Rate for Payer: UHCCP Medicaid |
$42.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.24
|
|
|
REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$2,565.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
76102820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.73 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$1,975.05
|
| Rate for Payer: Anthem Medicaid |
$882.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$616.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,000.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$863.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$832.59
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna Commercial |
$2,128.95
|
| Rate for Payer: First Health Commercial |
$2,436.75
|
| Rate for Payer: Humana Commercial |
$2,180.25
|
| Rate for Payer: Humana KY Medicaid |
$882.10
|
| Rate for Payer: Humana Medicare Advantage |
$616.73
|
| Rate for Payer: Kentucky WC Medicaid |
$891.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,103.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,892.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$899.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,257.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,923.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,052.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,231.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,769.85
|
| Rate for Payer: PHCS Commercial |
$2,462.40
|
| Rate for Payer: United Healthcare All Payer |
$2,257.20
|
|
|
REMOVE RENAL TUBE W/FLUORO (P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
761P2820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$40.46 |
| Max. Negotiated Rate |
$405.68 |
| Rate for Payer: Aetna Commercial |
$91.50
|
| Rate for Payer: Ambetter Exchange |
$50.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$40.46
|
| Rate for Payer: Anthem Medicaid |
$360.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.29
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$82.26
|
| Rate for Payer: Healthspan PPO |
$405.68
|
| Rate for Payer: Humana Medicaid |
$360.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$367.76
|
| Rate for Payer: Molina Healthcare Passport |
$360.55
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.31
|
| Rate for Payer: UHCCP Medicaid |
$42.48
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.16
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.24
|
|
|
REMOVE RENAL TUBE W/FLUORO (T
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
761T2820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$616.73 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Anthem Medicaid |
$730.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$616.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$863.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$832.59
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial |
$1,806.25
|
| Rate for Payer: Humana KY Medicaid |
$730.79
|
| Rate for Payer: Humana Medicare Advantage |
$616.73
|
| Rate for Payer: Kentucky WC Medicaid |
$738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$740.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.25
|
| Rate for Payer: PHCS Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Payer |
$1,870.00
|
|
|
REMOVE RENAL TUBE W/FLUORO (T
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS 50389
|
| Hospital Charge Code |
761T2820
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$637.50 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$1,636.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.50
|
| Rate for Payer: Cash Price |
$1,062.50
|
| Rate for Payer: Cigna Commercial |
$1,763.75
|
| Rate for Payer: First Health Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial |
$1,806.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.25
|
| Rate for Payer: PHCS Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare All Payer |
$1,870.00
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
76102871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
76102871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.75 |
| Max. Negotiated Rate |
$1,410.99 |
| Rate for Payer: Aetna Commercial |
$1,410.99
|
| Rate for Payer: Ambetter Exchange |
$816.53
|
| Rate for Payer: Anthem Medicaid |
$656.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$816.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$816.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$979.84
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$1,342.62
|
| Rate for Payer: Healthspan PPO |
$1,366.20
|
| Rate for Payer: Humana Medicaid |
$656.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,174.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$816.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.18
|
| Rate for Payer: Molina Healthcare Passport |
$656.06
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,061.49
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$662.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$816.53
|
|
|
REMOVE/REPLACE PENIS PROSTH
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 54410
|
| Hospital Charge Code |
76102871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$26,037.75 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,598.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,037.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,107.83
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$18,598.39
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,318.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE&REPLACE PM GEN SINGL
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
76101258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
REMOVE&REPLACE PM GEN SINGL
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
76101258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.11 |
| Max. Negotiated Rate |
$10,705.58 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,646.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,705.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,323.23
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$7,646.84
|
| Rate for Payer: Kentucky WC Medicaid |
$321.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,176.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
REMOVE&REPLACE PM GEN SINGL
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
76101258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$629.48 |
| Rate for Payer: Ambetter Exchange |
$315.92
|
| Rate for Payer: Anthem Medicaid |
$271.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.10
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$629.48
|
| Rate for Payer: Healthspan PPO |
$422.88
|
| Rate for Payer: Humana Medicaid |
$271.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.87
|
| Rate for Payer: Molina Healthcare Passport |
$271.44
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$410.70
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.92
|
|
|
REMOVE&REPLACE PM GEN SINGL(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 33227
|
| Hospital Charge Code |
761P1258
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.44 |
| Max. Negotiated Rate |
$629.48 |
| Rate for Payer: Ambetter Exchange |
$315.92
|
| Rate for Payer: Anthem Medicaid |
$271.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$379.10
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$629.48
|
| Rate for Payer: Healthspan PPO |
$422.88
|
| Rate for Payer: Humana Medicaid |
$271.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$453.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.87
|
| Rate for Payer: Molina Healthcare Passport |
$271.44
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$410.70
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.92
|
|
