|
REMOVE SHOULDER FB DEEP
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.97 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
REMOVE SHOULDER FB DEEP
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$842.01 |
| Rate for Payer: Ambetter Exchange |
$454.46
|
| Rate for Payer: Anthem Medicaid |
$356.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$454.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$454.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.35
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$842.01
|
| Rate for Payer: Healthspan PPO |
$659.03
|
| Rate for Payer: Humana Medicaid |
$356.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$454.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$363.25
|
| Rate for Payer: Molina Healthcare Passport |
$356.13
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$590.80
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$359.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$454.46
|
|
|
REMOVE SHOULDER FB DEEP
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
76100452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
REMOVE SHOULDER FB DEEP(P
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 23333
|
| Hospital Charge Code |
761P0452
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$842.01 |
| Rate for Payer: Ambetter Exchange |
$454.46
|
| Rate for Payer: Anthem Medicaid |
$356.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$454.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$454.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$545.35
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$842.01
|
| Rate for Payer: Healthspan PPO |
$659.03
|
| Rate for Payer: Humana Medicaid |
$356.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$580.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$454.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$363.25
|
| Rate for Payer: Molina Healthcare Passport |
$356.13
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$590.80
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$359.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$454.46
|
|
|
REMOVE SHOULDER JOINT LINING
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 23105
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,021.73 |
| Rate for Payer: Aetna Commercial |
$931.56
|
| Rate for Payer: Ambetter Exchange |
$612.60
|
| Rate for Payer: Anthem Medicaid |
$534.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$735.12
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,021.73
|
| Rate for Payer: Healthspan PPO |
$843.80
|
| Rate for Payer: Humana Medicaid |
$534.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$786.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.66
|
| Rate for Payer: Molina Healthcare Passport |
$534.96
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$796.38
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.60
|
|
|
REMOVE SHOULDER JOINT LINING
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 23105
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REMOVE SHOULDER JOINT LINING
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 23105
|
| Hospital Charge Code |
76100442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REMOVE SHOULDER JOINT LININ(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 23105
|
| Hospital Charge Code |
761P0442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,021.73 |
| Rate for Payer: Aetna Commercial |
$931.56
|
| Rate for Payer: Ambetter Exchange |
$612.60
|
| Rate for Payer: Anthem Medicaid |
$534.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$612.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$612.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$735.12
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,021.73
|
| Rate for Payer: Healthspan PPO |
$843.80
|
| Rate for Payer: Humana Medicaid |
$534.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$786.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$612.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.66
|
| Rate for Payer: Molina Healthcare Passport |
$534.96
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$796.38
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$612.60
|
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
76102368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.11 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| 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 |
$1,804.32
|
| 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 |
$2,165.18
|
| 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 SKIN NERVE LESION
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
76102368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.04 |
| Max. Negotiated Rate |
$642.40 |
| Rate for Payer: Aetna Commercial |
$642.40
|
| Rate for Payer: Ambetter Exchange |
$408.44
|
| Rate for Payer: Anthem Medicaid |
$227.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$408.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$408.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$490.13
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$582.48
|
| Rate for Payer: Healthspan PPO |
$501.57
|
| Rate for Payer: Humana Medicaid |
$227.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$408.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.58
|
| Rate for Payer: Molina Healthcare Passport |
$227.04
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$530.97
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$408.44
|
|
|
REMOVE SKIN NERVE LESION
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
76102368
|
|
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 SKIN NERVE LESION(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 64774
|
| Hospital Charge Code |
761P2368
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.04 |
| Max. Negotiated Rate |
$642.40 |
| Rate for Payer: Aetna Commercial |
$642.40
|
| Rate for Payer: Ambetter Exchange |
$408.44
|
| Rate for Payer: Anthem Medicaid |
$227.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$408.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$408.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$490.13
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$582.48
|
| Rate for Payer: Healthspan PPO |
$501.57
|
| Rate for Payer: Humana Medicaid |
$227.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$408.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$231.58
|
| Rate for Payer: Molina Healthcare Passport |
$227.04
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$530.97
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$229.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$408.44
|
|
|
REMOVE SPINE ELTRD PERQ ARA(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
761P2306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.67 |
| Max. Negotiated Rate |
$873.41 |
| Rate for Payer: Aetna Commercial |
$500.01
|
| Rate for Payer: Ambetter Exchange |
$313.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.67
|
| Rate for Payer: Anthem Medicaid |
$394.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$313.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.30
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$873.41
|
| Rate for Payer: Healthspan PPO |
$539.49
|
| Rate for Payer: Humana Medicaid |
$394.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$313.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$402.41
|
| Rate for Payer: Molina Healthcare Passport |
$394.52
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.65
|
| Rate for Payer: UHCCP Medicaid |
$176.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$398.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.58
|
|
|
REMOVE SPINE ELTRD PERQ ARAY
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
76102306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.67 |
| Max. Negotiated Rate |
$873.41 |
| Rate for Payer: Aetna Commercial |
$500.01
|
| Rate for Payer: Ambetter Exchange |
$313.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$167.67
|
| Rate for Payer: Anthem Medicaid |
$394.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$313.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$313.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$376.30
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$873.41
|
| Rate for Payer: Healthspan PPO |
$539.49
|
| Rate for Payer: Humana Medicaid |
$394.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$421.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$313.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$313.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$402.41
|
| Rate for Payer: Molina Healthcare Passport |
$394.52
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$407.65
|
| Rate for Payer: UHCCP Medicaid |
$176.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$398.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$313.58
|
|
|
REMOVE SPINE ELTRD PERQ ARAY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
76102306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REMOVE SPINE ELTRD PERQ ARAY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 63661
|
| Hospital Charge Code |
76102306
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REMOVE SPINE ELTRD PLATE
|
Facility
|
OP
|
$10,421.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
76102940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,177.58 |
| Max. Negotiated Rate |
$10,004.16 |
| Rate for Payer: Aetna Commercial |
$8,024.17
|
| Rate for Payer: Anthem Medicaid |
$3,583.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,177.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,128.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,448.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,289.73
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cigna Commercial |
$8,649.43
|
| Rate for Payer: First Health Commercial |
$9,899.95
|
| Rate for Payer: Humana Commercial |
$8,857.85
|
| Rate for Payer: Humana KY Medicaid |
$3,583.78
|
| Rate for Payer: Humana Medicare Advantage |
$3,177.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,620.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,545.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,690.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,813.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,655.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,170.48
|
| Rate for Payer: Ohio Health Group HMO |
$7,815.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,066.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,190.49
|
| Rate for Payer: PHCS Commercial |
$10,004.16
|
| Rate for Payer: United Healthcare All Payer |
$9,170.48
|
|
|
REMOVE SPINE ELTRD PLATE
|
Professional
|
Both
|
$10,421.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
76102940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.42 |
| Max. Negotiated Rate |
$6,252.60 |
| Rate for Payer: Aetna Commercial |
$1,166.70
|
| Rate for Payer: Ambetter Exchange |
$816.89
|
| Rate for Payer: Anthem Medicaid |
$514.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$816.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$816.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$980.27
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cigna Commercial |
$1,141.46
|
| Rate for Payer: Healthspan PPO |
$717.13
|
| Rate for Payer: Humana Medicaid |
$514.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$915.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$816.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$524.71
|
| Rate for Payer: Molina Healthcare Passport |
$514.42
|
| Rate for Payer: Multiplan PHCS |
$6,252.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,061.96
|
| Rate for Payer: UHCCP Medicaid |
$3,647.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$816.89
|
|
|
REMOVE SPINE ELTRD PLATE
|
Facility
|
IP
|
$10,421.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
76102940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,126.30 |
| Max. Negotiated Rate |
$10,004.16 |
| Rate for Payer: Aetna Commercial |
$8,024.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,128.38
|
| Rate for Payer: Cash Price |
$5,210.50
|
| Rate for Payer: Cigna Commercial |
$8,649.43
|
| Rate for Payer: First Health Commercial |
$9,899.95
|
| Rate for Payer: Humana Commercial |
$8,857.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,545.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,690.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,126.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,170.48
|
| Rate for Payer: Ohio Health Group HMO |
$7,815.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,066.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,190.49
|
| Rate for Payer: PHCS Commercial |
$10,004.16
|
| Rate for Payer: United Healthcare All Payer |
$9,170.48
|
|
|
REMOVE SPINE ELTRD PLATE (P
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
761P2940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.42 |
| Max. Negotiated Rate |
$1,237.80 |
| Rate for Payer: Aetna Commercial |
$1,166.70
|
| Rate for Payer: Ambetter Exchange |
$816.89
|
| Rate for Payer: Anthem Medicaid |
$514.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$816.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$816.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$980.27
|
| Rate for Payer: Cash Price |
$1,031.50
|
| Rate for Payer: Cash Price |
$1,031.50
|
| Rate for Payer: Cigna Commercial |
$1,141.46
|
| Rate for Payer: Healthspan PPO |
$717.13
|
| Rate for Payer: Humana Medicaid |
$514.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$915.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$816.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$524.71
|
| Rate for Payer: Molina Healthcare Passport |
$514.42
|
| Rate for Payer: Multiplan PHCS |
$1,237.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,061.96
|
| Rate for Payer: UHCCP Medicaid |
$722.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$519.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$816.89
|
|
|
REMOVE SPINE ELTRD PLATE (T
|
Facility
|
IP
|
$8,358.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
761T2940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,507.40 |
| Max. Negotiated Rate |
$8,023.68 |
| Rate for Payer: Aetna Commercial |
$6,435.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.24
|
| Rate for Payer: Cash Price |
$4,179.00
|
| Rate for Payer: Cigna Commercial |
$6,937.14
|
| Rate for Payer: First Health Commercial |
$7,940.10
|
| Rate for Payer: Humana Commercial |
$7,104.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.02
|
| Rate for Payer: PHCS Commercial |
$8,023.68
|
| Rate for Payer: United Healthcare All Payer |
$7,355.04
|
|
|
REMOVE SPINE ELTRD PLATE (T
|
Facility
|
OP
|
$8,358.00
|
|
|
Service Code
|
HCPCS 63662
|
| Hospital Charge Code |
761T2940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,874.32 |
| Max. Negotiated Rate |
$8,023.68 |
| Rate for Payer: Aetna Commercial |
$6,435.66
|
| Rate for Payer: Anthem Medicaid |
$2,874.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,177.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,519.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,448.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,289.73
|
| Rate for Payer: Cash Price |
$4,179.00
|
| Rate for Payer: Cash Price |
$4,179.00
|
| Rate for Payer: Cigna Commercial |
$6,937.14
|
| Rate for Payer: First Health Commercial |
$7,940.10
|
| Rate for Payer: Humana Commercial |
$7,104.30
|
| Rate for Payer: Humana KY Medicaid |
$2,874.32
|
| Rate for Payer: Humana Medicare Advantage |
$3,177.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,853.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,168.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,813.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,355.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,268.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,271.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,767.02
|
| Rate for Payer: PHCS Commercial |
$8,023.68
|
| Rate for Payer: United Healthcare All Payer |
$7,355.04
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
IP
|
$2,989.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
761T0226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$896.85 |
| Max. Negotiated Rate |
$2,869.92 |
| Rate for Payer: Aetna Commercial |
$2,301.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.81
|
| Rate for Payer: Cash Price |
$1,494.75
|
| Rate for Payer: Cigna Commercial |
$2,481.28
|
| Rate for Payer: First Health Commercial |
$2,840.03
|
| Rate for Payer: Humana Commercial |
$2,541.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$896.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,391.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.76
|
| Rate for Payer: PHCS Commercial |
$2,869.92
|
| Rate for Payer: United Healthcare All Payer |
$2,630.76
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
OP
|
$2,989.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
761T0226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,028.09 |
| Max. Negotiated Rate |
$2,869.92 |
| Rate for Payer: Aetna Commercial |
$2,301.91
|
| Rate for Payer: Anthem Medicaid |
$1,028.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,331.81
|
| 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 |
$1,494.75
|
| Rate for Payer: Cash Price |
$1,494.75
|
| Rate for Payer: Cigna Commercial |
$2,481.28
|
| Rate for Payer: First Health Commercial |
$2,840.03
|
| Rate for Payer: Humana Commercial |
$2,541.07
|
| Rate for Payer: Humana KY Medicaid |
$1,028.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,038.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,451.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,206.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,048.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,630.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,242.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,391.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,600.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,062.76
|
| Rate for Payer: PHCS Commercial |
$2,869.92
|
| Rate for Payer: United Healthcare All Payer |
$2,630.76
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
OP
|
$3,639.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,251.62 |
| Max. Negotiated Rate |
$3,493.92 |
| Rate for Payer: Aetna Commercial |
$2,802.41
|
| Rate for Payer: Anthem Medicaid |
$1,251.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,838.81
|
| 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 |
$1,819.75
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cigna Commercial |
$3,020.78
|
| Rate for Payer: First Health Commercial |
$3,457.53
|
| Rate for Payer: Humana Commercial |
$3,093.57
|
| Rate for Payer: Humana KY Medicaid |
$1,251.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,264.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,984.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,685.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,276.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,202.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,729.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,911.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,166.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.26
|
| Rate for Payer: PHCS Commercial |
$3,493.92
|
| Rate for Payer: United Healthcare All Payer |
$3,202.76
|
|
