|
REMOVE TUNNELED IP CATH
|
Facility
|
IP
|
$7,116.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
76102000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,134.80 |
| Max. Negotiated Rate |
$6,831.36 |
| Rate for Payer: Aetna Commercial |
$5,479.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,550.48
|
| 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: 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 |
$2,134.80
|
| 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(P
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
761P2000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.34 |
| Max. Negotiated Rate |
$582.00 |
| 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 |
$485.00
|
| Rate for Payer: Cash Price |
$485.00
|
| 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 |
$582.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$272.14
|
| Rate for Payer: UHCCP Medicaid |
$339.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$305.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$209.34
|
|
|
REMOVE TUNNELED IP CATH(T
|
Facility
|
OP
|
$6,146.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
761T2000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,113.61 |
| Max. Negotiated Rate |
$5,900.16 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Anthem Medicaid |
$2,113.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,793.88
|
| 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 |
$3,073.00
|
| Rate for Payer: Cash Price |
$3,073.00
|
| Rate for Payer: Cigna Commercial |
$5,101.18
|
| Rate for Payer: First Health Commercial |
$5,838.70
|
| Rate for Payer: Humana Commercial |
$5,224.10
|
| Rate for Payer: Humana KY Medicaid |
$2,113.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,135.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,039.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,535.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,156.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,408.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,609.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,916.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,347.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,240.74
|
| Rate for Payer: PHCS Commercial |
$5,900.16
|
| Rate for Payer: United Healthcare All Payer |
$5,408.48
|
|
|
REMOVE TUNNELED IP CATH(T
|
Facility
|
IP
|
$6,146.00
|
|
|
Service Code
|
HCPCS 49422
|
| Hospital Charge Code |
761T2000
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,843.80 |
| Max. Negotiated Rate |
$5,900.16 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,793.88
|
| Rate for Payer: Cash Price |
$3,073.00
|
| Rate for Payer: Cigna Commercial |
$5,101.18
|
| Rate for Payer: First Health Commercial |
$5,838.70
|
| Rate for Payer: Humana Commercial |
$5,224.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,039.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,535.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,843.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,408.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,609.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,916.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,347.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,240.74
|
| Rate for Payer: PHCS Commercial |
$5,900.16
|
| Rate for Payer: United Healthcare All Payer |
$5,408.48
|
|
|
REMOVE UTERUS AFTER CESAREAN
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 59525
|
| Hospital Charge Code |
76102724
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$815.62 |
| Rate for Payer: Aetna Commercial |
$815.62
|
| Rate for Payer: Ambetter Exchange |
$459.41
|
| Rate for Payer: Anthem Medicaid |
$374.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$459.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$459.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$551.29
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$751.75
|
| Rate for Payer: Healthspan PPO |
$591.98
|
| Rate for Payer: Humana Medicaid |
$374.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$652.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$459.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.65
|
| Rate for Payer: Molina Healthcare Passport |
$374.17
|
| Rate for Payer: Multiplan PHCS |
$417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$597.23
|
| Rate for Payer: UHCCP Medicaid |
$243.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$459.41
|
|
|
REMOVE VAGINA LESION
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,788.50 |
| Rate for Payer: Anthem Medicaid |
$741.00
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: Cash Price |
$1,277.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$741.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$755.82
|
| Rate for Payer: Molina Healthcare Passport |
$741.00
|
| Rate for Payer: Multiplan PHCS |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,788.50
|
| Rate for Payer: UHCCP Medicaid |
$894.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$748.41
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
761P2613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$239.31 |
| Rate for Payer: Aetna Commercial |
$239.31
|
| Rate for Payer: Ambetter Exchange |
$164.63
|
| Rate for Payer: Anthem Medicaid |
$37.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.56
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$228.10
|
| Rate for Payer: Healthspan PPO |
$231.71
|
| Rate for Payer: Humana Medicaid |
$37.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$164.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.32
|
| Rate for Payer: Molina Healthcare Passport |
$37.57
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.02
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.63
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
76102613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.57 |
| Max. Negotiated Rate |
$239.31 |
| Rate for Payer: Aetna Commercial |
$239.31
|
| Rate for Payer: Ambetter Exchange |
$164.63
|
| Rate for Payer: Anthem Medicaid |
$37.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$197.56
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$228.10
|
| Rate for Payer: Healthspan PPO |
$231.71
|
| Rate for Payer: Humana Medicaid |
$37.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$206.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$164.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.32
|
| Rate for Payer: Molina Healthcare Passport |
$37.57
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$214.02
|
| Rate for Payer: UHCCP Medicaid |
$129.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.63
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
76102613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.60
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
REMOVE VAGINAL FOREIGN BODY
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 57415
|
| Hospital Charge Code |
76102613
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.24 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem Medicaid |
$127.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Humana KY Medicaid |
$127.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$128.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
REMOVE VENTRICULAR DEVICE
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
76101330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
REMOVE VENTRICULAR DEVICE
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
76101330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$893.09 |
| Max. Negotiated Rate |
$2,057.70 |
| Rate for Payer: Aetna Commercial |
$2,057.70
|
| Rate for Payer: Ambetter Exchange |
$1,054.85
|
| Rate for Payer: Anthem Medicaid |
$893.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,054.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,054.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,265.82
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,969.16
|
| Rate for Payer: Healthspan PPO |
$2,023.12
|
| Rate for Payer: Humana Medicaid |
$893.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,688.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,054.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$910.95
|
| Rate for Payer: Molina Healthcare Passport |
$893.09
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,371.31
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$902.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,054.85
|
|
|
REMOVE VENTRICULAR DEVICE
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
76101330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
REMOVE VENTRICULAR DEVICE(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 33977
|
| Hospital Charge Code |
761P1330
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$893.09 |
| Max. Negotiated Rate |
$2,057.70 |
| Rate for Payer: Aetna Commercial |
$2,057.70
|
| Rate for Payer: Ambetter Exchange |
$1,054.85
|
| Rate for Payer: Anthem Medicaid |
$893.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,054.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,054.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,265.82
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,969.16
|
| Rate for Payer: Healthspan PPO |
$2,023.12
|
| Rate for Payer: Humana Medicaid |
$893.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,688.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,054.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$910.95
|
| Rate for Payer: Molina Healthcare Passport |
$893.09
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,371.31
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$902.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,054.85
|
|
|
REMOVE WRIST/FOREARM LESION
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
76100584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,270.40 |
| Rate for Payer: Aetna Commercial |
$933.21
|
| Rate for Payer: Ambetter Exchange |
$578.67
|
| Rate for Payer: Anthem Medicaid |
$441.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$578.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$578.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$694.40
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$1,270.40
|
| Rate for Payer: Healthspan PPO |
$845.29
|
| Rate for Payer: Humana Medicaid |
$441.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$578.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$450.47
|
| Rate for Payer: Molina Healthcare Passport |
$441.64
|
| Rate for Payer: Multiplan PHCS |
$474.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.27
|
| Rate for Payer: UHCCP Medicaid |
$276.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$446.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$578.67
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
76100584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$608.30
|
| Rate for Payer: Anthem Medicaid |
$271.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.20
|
| 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 |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$655.70
|
| Rate for Payer: First Health Commercial |
$750.50
|
| Rate for Payer: Humana Commercial |
$671.50
|
| Rate for Payer: Humana KY Medicaid |
$271.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$274.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.20
|
| Rate for Payer: Ohio Health Group HMO |
$592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.10
|
| Rate for Payer: PHCS Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Payer |
$695.20
|
|
|
REMOVE WRIST/FOREARM LESION
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
76100584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$758.40 |
| Rate for Payer: Aetna Commercial |
$608.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.20
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$655.70
|
| Rate for Payer: First Health Commercial |
$750.50
|
| Rate for Payer: Humana Commercial |
$671.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.20
|
| Rate for Payer: Ohio Health Group HMO |
$592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.10
|
| Rate for Payer: PHCS Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Payer |
$695.20
|
|
|
REMOVE WRIST/FOREARM LESION(P
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
761P0584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,270.40 |
| Rate for Payer: Aetna Commercial |
$933.21
|
| Rate for Payer: Ambetter Exchange |
$578.67
|
| Rate for Payer: Anthem Medicaid |
$441.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$578.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$578.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$694.40
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$1,270.40
|
| Rate for Payer: Healthspan PPO |
$845.29
|
| Rate for Payer: Humana Medicaid |
$441.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$578.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$450.47
|
| Rate for Payer: Molina Healthcare Passport |
$441.64
|
| Rate for Payer: Multiplan PHCS |
$474.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.27
|
| Rate for Payer: UHCCP Medicaid |
$276.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$446.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$578.67
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
76100580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.08 |
| Max. Negotiated Rate |
$1,016.37 |
| Rate for Payer: Aetna Commercial |
$875.41
|
| Rate for Payer: Ambetter Exchange |
$593.08
|
| Rate for Payer: Anthem Medicaid |
$336.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$593.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$593.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$711.70
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,016.37
|
| Rate for Payer: Healthspan PPO |
$792.93
|
| Rate for Payer: Humana Medicaid |
$336.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$593.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.80
|
| Rate for Payer: Molina Healthcare Passport |
$336.08
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$771.00
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$593.08
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
76100580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.45 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| 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 |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
76100580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.50 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE WRIST JOINT CARTILAG(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
761P0580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.08 |
| Max. Negotiated Rate |
$1,016.37 |
| Rate for Payer: Aetna Commercial |
$875.41
|
| Rate for Payer: Ambetter Exchange |
$593.08
|
| Rate for Payer: Anthem Medicaid |
$336.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$593.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$593.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$711.70
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,016.37
|
| Rate for Payer: Healthspan PPO |
$792.93
|
| Rate for Payer: Humana Medicaid |
$336.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$593.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.80
|
| Rate for Payer: Molina Healthcare Passport |
$336.08
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$771.00
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$593.08
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
76100616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$642.82 |
| Max. Negotiated Rate |
$1,672.58 |
| Rate for Payer: Aetna Commercial |
$1,527.82
|
| Rate for Payer: Ambetter Exchange |
$982.96
|
| Rate for Payer: Anthem Medicaid |
$642.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$982.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$982.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,179.55
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,672.58
|
| Rate for Payer: Healthspan PPO |
$1,383.88
|
| Rate for Payer: Humana Medicaid |
$642.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,302.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$982.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$655.68
|
| Rate for Payer: Molina Healthcare Passport |
$642.82
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,277.85
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$649.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$982.96
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
76100616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$773.77 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| 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 |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Humana KY Medicaid |
$773.77
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
76100616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
