|
REMOVE SUTURE UNDER ANESTHESIC
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
761P0226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$67.84
|
| Rate for Payer: Ambetter Exchange |
$61.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.05
|
| Rate for Payer: Anthem Medicaid |
$34.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$136.54
|
| Rate for Payer: Healthspan PPO |
$102.60
|
| Rate for Payer: Humana Medicaid |
$34.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.69
|
| Rate for Payer: Molina Healthcare Passport |
$34.01
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.25
|
| Rate for Payer: UHCCP Medicaid |
$35.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.73
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Facility
|
IP
|
$3,639.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,091.85 |
| Max. Negotiated Rate |
$3,493.92 |
| Rate for Payer: Aetna Commercial |
$2,802.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,838.81
|
| 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: 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 |
$1,091.85
|
| 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
|
|
|
REMOVE SUTURE UNDER ANESTHESIC
|
Professional
|
Both
|
$3,639.50
|
|
|
Service Code
|
HCPCS 15851
|
| Hospital Charge Code |
76100226
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$2,183.70 |
| Rate for Payer: Aetna Commercial |
$67.84
|
| Rate for Payer: Ambetter Exchange |
$61.73
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$34.05
|
| Rate for Payer: Anthem Medicaid |
$34.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.08
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cash Price |
$1,819.75
|
| Rate for Payer: Cigna Commercial |
$136.54
|
| Rate for Payer: Healthspan PPO |
$102.60
|
| Rate for Payer: Humana Medicaid |
$34.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$61.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.69
|
| Rate for Payer: Molina Healthcare Passport |
$34.01
|
| Rate for Payer: Multiplan PHCS |
$2,183.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.25
|
| Rate for Payer: UHCCP Medicaid |
$35.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.73
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
76102279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.60
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
REMOVE THYROID DUCT LESION
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
76102279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.22 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,108.80
|
| Rate for Payer: Anthem Medicaid |
$495.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,195.20
|
| Rate for Payer: First Health Commercial |
$1,368.00
|
| Rate for Payer: Humana Commercial |
$1,224.00
|
| Rate for Payer: Humana KY Medicaid |
$495.22
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$500.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,180.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,062.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,267.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,252.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.60
|
| Rate for Payer: PHCS Commercial |
$1,382.40
|
| Rate for Payer: United Healthcare All Payer |
$1,267.20
|
|
|
REMOVE THYROID DUCT LESION
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
76102279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.26 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$633.38
|
| Rate for Payer: Ambetter Exchange |
$428.69
|
| Rate for Payer: Anthem Medicaid |
$380.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$428.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$428.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$514.43
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$601.57
|
| Rate for Payer: Healthspan PPO |
$534.14
|
| Rate for Payer: Humana Medicaid |
$380.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$564.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$428.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$428.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.87
|
| Rate for Payer: Molina Healthcare Passport |
$380.26
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$557.30
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$428.69
|
|
|
REMOVE THYROID DUCT LESION(P
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 60280
|
| Hospital Charge Code |
761P2279
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.26 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$633.38
|
| Rate for Payer: Ambetter Exchange |
$428.69
|
| Rate for Payer: Anthem Medicaid |
$380.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$428.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$428.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$514.43
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$601.57
|
| Rate for Payer: Healthspan PPO |
$534.14
|
| Rate for Payer: Humana Medicaid |
$380.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$564.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$428.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$428.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.87
|
| Rate for Payer: Molina Healthcare Passport |
$380.26
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$557.30
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$428.69
|
|
|
REMOVE TISSUE EXPANDER(S)
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.93 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem Medicaid |
$257.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| 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 |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Humana KY Medicaid |
$257.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$260.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVE TISSUE EXPANDER(S)
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$678.76 |
| Rate for Payer: Aetna Commercial |
$417.89
|
| Rate for Payer: Ambetter Exchange |
$522.12
|
| Rate for Payer: Anthem Medicaid |
$125.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$522.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.54
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$402.16
|
| Rate for Payer: Healthspan PPO |
$495.49
|
| Rate for Payer: Humana Medicaid |
$125.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$522.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.44
|
| Rate for Payer: Molina Healthcare Passport |
$125.92
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.76
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$522.12
|
|
|
REMOVE TISSUE EXPANDER(S)
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
76100114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$577.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$585.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$622.50
|
| Rate for Payer: First Health Commercial |
$712.50
|
| Rate for Payer: Humana Commercial |
$637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$615.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$553.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$660.00
|
| Rate for Payer: Ohio Health Group HMO |
$562.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$517.50
|
| Rate for Payer: PHCS Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Payer |
$660.00
|
|
|
REMOVE TISSUE EXPANDER(S)(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 11971
|
| Hospital Charge Code |
761P0114
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.92 |
| Max. Negotiated Rate |
$678.76 |
| Rate for Payer: Aetna Commercial |
$417.89
|
| Rate for Payer: Ambetter Exchange |
$522.12
|
| Rate for Payer: Anthem Medicaid |
$125.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$522.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$522.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$626.54
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$402.16
|
| Rate for Payer: Healthspan PPO |
$495.49
|
| Rate for Payer: Humana Medicaid |
$125.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$522.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.44
|
| Rate for Payer: Molina Healthcare Passport |
$125.92
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$678.76
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$522.12
|
|
|
REMOVE/TRANSPLANT TENDON
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| 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 |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
REMOVE/TRANSPLANT TENDON
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
REMOVE/TRANSPLANT TENDON
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
76100461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$1,242.35 |
| Rate for Payer: Aetna Commercial |
$1,129.38
|
| Rate for Payer: Ambetter Exchange |
$721.25
|
| Rate for Payer: Anthem Medicaid |
$516.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$721.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$721.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$865.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,242.35
|
| Rate for Payer: Healthspan PPO |
$1,022.98
|
| Rate for Payer: Humana Medicaid |
$516.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$940.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$721.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.86
|
| Rate for Payer: Molina Healthcare Passport |
$516.53
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$937.62
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$721.25
|
|
|
REMOVE/TRANSPLANT TENDON(P
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 23440
|
| Hospital Charge Code |
761P0461
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$1,242.35 |
| Rate for Payer: Aetna Commercial |
$1,129.38
|
| Rate for Payer: Ambetter Exchange |
$721.25
|
| Rate for Payer: Anthem Medicaid |
$516.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$721.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$721.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$865.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,242.35
|
| Rate for Payer: Healthspan PPO |
$1,022.98
|
| Rate for Payer: Humana Medicaid |
$516.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$940.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$721.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$721.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$526.86
|
| Rate for Payer: Molina Healthcare Passport |
$516.53
|
| Rate for Payer: Multiplan PHCS |
$1,065.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$937.62
|
| Rate for Payer: UHCCP Medicaid |
$621.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$521.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$721.25
|
|
|
REMOVE TUMOR - HAND/FINGER
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
76100670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REMOVE TUMOR - HAND/FINGER
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
76100670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
REMOVE TUMOR - HAND/FINGER
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
76100670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.89 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$936.27
|
| Rate for Payer: Ambetter Exchange |
$712.41
|
| Rate for Payer: Anthem Medicaid |
$399.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$712.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$712.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$854.89
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,026.20
|
| Rate for Payer: Healthspan PPO |
$848.06
|
| Rate for Payer: Humana Medicaid |
$399.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$902.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$712.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.89
|
| Rate for Payer: Molina Healthcare Passport |
$399.89
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$926.13
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$712.41
|
|
|
REMOVE TUMOR - HAND/FINGER(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26117
|
| Hospital Charge Code |
761P0670
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.89 |
| Max. Negotiated Rate |
$1,026.20 |
| Rate for Payer: Aetna Commercial |
$936.27
|
| Rate for Payer: Ambetter Exchange |
$712.41
|
| Rate for Payer: Anthem Medicaid |
$399.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$712.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$712.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$854.89
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,026.20
|
| Rate for Payer: Healthspan PPO |
$848.06
|
| Rate for Payer: Humana Medicaid |
$399.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$902.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$712.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$407.89
|
| Rate for Payer: Molina Healthcare Passport |
$399.89
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$926.13
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$403.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$712.41
|
|
|
REMOVE TUMOR - LOWER LEG
|
Facility
|
IP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
76100894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
REMOVE TUMOR - LOWER LEG
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
76100894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.21 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,301.83
|
| Rate for Payer: Ambetter Exchange |
$962.68
|
| Rate for Payer: Anthem Medicaid |
$601.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$962.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$962.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,155.22
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,459.46
|
| Rate for Payer: Healthspan PPO |
$1,179.18
|
| Rate for Payer: Humana Medicaid |
$601.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,277.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$613.23
|
| Rate for Payer: Molina Healthcare Passport |
$601.21
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,251.48
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$607.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$962.68
|
|
|
REMOVE TUMOR - LOWER LEG
|
Facility
|
OP
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
76100894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,375.60 |
| Max. Negotiated Rate |
$3,840.00 |
| Rate for Payer: Aetna Commercial |
$3,080.00
|
| Rate for Payer: Anthem Medicaid |
$1,375.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,120.00
|
| 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 |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$3,320.00
|
| Rate for Payer: First Health Commercial |
$3,800.00
|
| Rate for Payer: Humana Commercial |
$3,400.00
|
| Rate for Payer: Humana KY Medicaid |
$1,375.60
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,280.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,952.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,520.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,480.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,760.00
|
| Rate for Payer: PHCS Commercial |
$3,840.00
|
| Rate for Payer: United Healthcare All Payer |
$3,520.00
|
|
|
REMOVE TUMOR - LOWER LEG(P
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 27615
|
| Hospital Charge Code |
761P0894
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.21 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,301.83
|
| Rate for Payer: Ambetter Exchange |
$962.68
|
| Rate for Payer: Anthem Medicaid |
$601.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$962.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$962.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,155.22
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$1,459.46
|
| Rate for Payer: Healthspan PPO |
$1,179.18
|
| Rate for Payer: Humana Medicaid |
$601.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,277.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$962.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$613.23
|
| Rate for Payer: Molina Healthcare Passport |
$601.21
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,251.48
|
| Rate for Payer: UHCCP Medicaid |
$1,400.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$607.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$962.68
|
|
|
REMOVE TUNNELED IP CATH
|
Facility
|
OP
|
$7,116.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
76102000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,447.19 |
| Max. Negotiated Rate |
$6,831.36 |
| Rate for Payer: Aetna Commercial |
$5,479.32
|
| Rate for Payer: Anthem Medicaid |
$2,447.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,550.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cigna Commercial |
$5,906.28
|
| Rate for Payer: First Health Commercial |
$6,760.20
|
| Rate for Payer: Humana Commercial |
$6,048.60
|
| Rate for Payer: Humana KY Medicaid |
$2,447.19
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,472.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,835.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,251.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,496.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,262.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,337.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,190.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,910.04
|
| Rate for Payer: PHCS Commercial |
$6,831.36
|
| Rate for Payer: United Healthcare All Payer |
$6,262.08
|
|
|
REMOVE TUNNELED IP CATH
|
Professional
|
Both
|
$7,116.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
76102000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.34 |
| Max. Negotiated Rate |
$4,269.60 |
| Rate for Payer: Aetna Commercial |
$568.72
|
| Rate for Payer: Ambetter Exchange |
$209.34
|
| Rate for Payer: Anthem Medicaid |
$302.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$209.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$209.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$251.21
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cash Price |
$3,558.00
|
| Rate for Payer: Cigna Commercial |
$534.92
|
| Rate for Payer: Healthspan PPO |
$479.61
|
| Rate for Payer: Humana Medicaid |
$302.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$491.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$209.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$209.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$308.43
|
| Rate for Payer: Molina Healthcare Passport |
$302.38
|
| Rate for Payer: Multiplan PHCS |
$4,269.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.14
|
| Rate for Payer: UHCCP Medicaid |
$2,490.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.34
|
|
