|
REMOVE WRIST JOINT IMPLANT(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
761P0616
|
|
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 LINING
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
76100579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.77 |
| Max. Negotiated Rate |
$846.62 |
| Rate for Payer: Aetna Commercial |
$707.98
|
| Rate for Payer: Ambetter Exchange |
$467.42
|
| Rate for Payer: Anthem Medicaid |
$382.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$560.90
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$846.62
|
| Rate for Payer: Healthspan PPO |
$641.28
|
| Rate for Payer: Humana Medicaid |
$382.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$598.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$467.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.43
|
| Rate for Payer: Molina Healthcare Passport |
$382.77
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$607.65
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.42
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
76100579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$428.16 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem Medicaid |
$428.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| 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 |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Humana KY Medicaid |
$428.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$432.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$436.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
76100579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$373.50 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,083.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$859.05
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
REMOVE WRIST JOINT LINING(P
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
761P0579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.77 |
| Max. Negotiated Rate |
$846.62 |
| Rate for Payer: Aetna Commercial |
$707.98
|
| Rate for Payer: Ambetter Exchange |
$467.42
|
| Rate for Payer: Anthem Medicaid |
$382.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$560.90
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$846.62
|
| Rate for Payer: Healthspan PPO |
$641.28
|
| Rate for Payer: Humana Medicaid |
$382.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$598.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$467.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.43
|
| Rate for Payer: Molina Healthcare Passport |
$382.77
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$607.65
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.42
|
|
|
REMOVE WRIST TENDON LESION
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
76100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$689.35 |
| Rate for Payer: Aetna Commercial |
$514.65
|
| Rate for Payer: Ambetter Exchange |
$332.04
|
| Rate for Payer: Anthem Medicaid |
$197.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$332.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$398.45
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$689.35
|
| Rate for Payer: Healthspan PPO |
$466.16
|
| Rate for Payer: Humana Medicaid |
$197.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$428.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$332.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.44
|
| Rate for Payer: Molina Healthcare Passport |
$197.49
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$431.65
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.04
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
76100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$288.88 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
76100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REMOVE WRIST TENDON LESION(P
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
761P0581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$689.35 |
| Rate for Payer: Aetna Commercial |
$514.65
|
| Rate for Payer: Ambetter Exchange |
$332.04
|
| Rate for Payer: Anthem Medicaid |
$197.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$332.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$332.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$398.45
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$689.35
|
| Rate for Payer: Healthspan PPO |
$466.16
|
| Rate for Payer: Humana Medicaid |
$197.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$428.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$332.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.44
|
| Rate for Payer: Molina Healthcare Passport |
$197.49
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$431.65
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$332.04
|
|
|
REMOV FOREIGN BODY
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
76102411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,282.75 |
| Max. Negotiated Rate |
$3,580.80 |
| Rate for Payer: Aetna Commercial |
$2,872.10
|
| Rate for Payer: Anthem Medicaid |
$1,282.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cigna Commercial |
$3,095.90
|
| Rate for Payer: First Health Commercial |
$3,543.50
|
| Rate for Payer: Humana Commercial |
$3,170.50
|
| Rate for Payer: Humana KY Medicaid |
$1,282.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.70
|
| Rate for Payer: PHCS Commercial |
$3,580.80
|
| Rate for Payer: United Healthcare All Payer |
$3,282.40
|
|
|
REMOV FOREIGN BODY
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
76102411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,119.00 |
| Max. Negotiated Rate |
$3,580.80 |
| Rate for Payer: Aetna Commercial |
$2,872.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.40
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cigna Commercial |
$3,095.90
|
| Rate for Payer: First Health Commercial |
$3,543.50
|
| Rate for Payer: Humana Commercial |
$3,170.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,573.70
|
| Rate for Payer: PHCS Commercial |
$3,580.80
|
| Rate for Payer: United Healthcare All Payer |
$3,282.40
|
|
|
REMOV FOREIGN BODY
|
Professional
|
Both
|
$3,730.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
76102411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$2,238.00 |
| Rate for Payer: Aetna Commercial |
$144.36
|
| Rate for Payer: Ambetter Exchange |
$88.69
|
| Rate for Payer: Anthem Medicaid |
$65.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.43
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Healthspan PPO |
$128.06
|
| Rate for Payer: Humana Medicaid |
$65.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.42
|
| Rate for Payer: Molina Healthcare Passport |
$65.12
|
| Rate for Payer: Multiplan PHCS |
$2,238.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.30
|
| Rate for Payer: UHCCP Medicaid |
$1,305.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.69
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
761P2410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna Commercial |
$80.84
|
| Rate for Payer: Ambetter Exchange |
$45.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.26
|
| Rate for Payer: Anthem Medicaid |
$34.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.14
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$174.85
|
| Rate for Payer: Healthspan PPO |
$147.20
|
| Rate for Payer: Humana Medicaid |
$34.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.53
|
| Rate for Payer: Molina Healthcare Passport |
$34.83
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$27.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.12
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
45000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
761T2410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
76102410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.10 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.26
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.23
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
76102410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$280.20 |
| Rate for Payer: Aetna Commercial |
$80.84
|
| Rate for Payer: Ambetter Exchange |
$45.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.26
|
| Rate for Payer: Anthem Medicaid |
$34.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$54.14
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$174.85
|
| Rate for Payer: Healthspan PPO |
$147.20
|
| Rate for Payer: Humana Medicaid |
$34.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.48
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.53
|
| Rate for Payer: Molina Healthcare Passport |
$34.83
|
| Rate for Payer: Multiplan PHCS |
$280.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$27.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.12
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
45000307
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
76102410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$448.32 |
| Rate for Payer: Aetna Commercial |
$359.59
|
| Rate for Payer: Anthem Medicaid |
$160.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$364.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cash Price |
$233.50
|
| Rate for Payer: Cigna Commercial |
$387.61
|
| Rate for Payer: First Health Commercial |
$443.65
|
| Rate for Payer: Humana Commercial |
$396.95
|
| Rate for Payer: Humana KY Medicaid |
$160.60
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$162.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$382.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$344.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$163.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$410.96
|
| Rate for Payer: Ohio Health Group HMO |
$350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.23
|
| Rate for Payer: PHCS Commercial |
$448.32
|
| Rate for Payer: United Healthcare All Payer |
$410.96
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
761T2410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
REMOV FOREIGN BODY(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
761P2411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna Commercial |
$144.36
|
| Rate for Payer: Ambetter Exchange |
$88.69
|
| Rate for Payer: Anthem Medicaid |
$65.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$88.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$88.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.43
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Healthspan PPO |
$128.06
|
| Rate for Payer: Humana Medicaid |
$65.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$88.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.42
|
| Rate for Payer: Molina Healthcare Passport |
$65.12
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.30
|
| Rate for Payer: UHCCP Medicaid |
$157.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$88.69
|
|
|
REMOV FOREIGN BODY(T
|
Facility
|
OP
|
$3,280.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
761T2411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,127.99 |
| Max. Negotiated Rate |
$3,148.80 |
| Rate for Payer: Aetna Commercial |
$2,525.60
|
| Rate for Payer: Anthem Medicaid |
$1,127.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cigna Commercial |
$2,722.40
|
| Rate for Payer: First Health Commercial |
$3,116.00
|
| Rate for Payer: Humana Commercial |
$2,788.00
|
| Rate for Payer: Humana KY Medicaid |
$1,127.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,139.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,689.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,420.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,150.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,263.20
|
| Rate for Payer: PHCS Commercial |
$3,148.80
|
| Rate for Payer: United Healthcare All Payer |
$2,886.40
|
|
|
REMOV FOREIGN BODY(T
|
Facility
|
IP
|
$3,280.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
761T2411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$984.00 |
| Max. Negotiated Rate |
$3,148.80 |
| Rate for Payer: Aetna Commercial |
$2,525.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.40
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cigna Commercial |
$2,722.40
|
| Rate for Payer: First Health Commercial |
$3,116.00
|
| Rate for Payer: Humana Commercial |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,689.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,420.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,624.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,853.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,263.20
|
| Rate for Payer: PHCS Commercial |
$3,148.80
|
| Rate for Payer: United Healthcare All Payer |
$2,886.40
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
761T1632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.88 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Anthem Medicaid |
$223.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$540.33
|
| Rate for Payer: First Health Commercial |
$618.45
|
| Rate for Payer: Humana Commercial |
$553.35
|
| Rate for Payer: Humana KY Medicaid |
$223.88
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$226.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$480.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.88
|
| Rate for Payer: Ohio Health Group HMO |
$488.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.19
|
| Rate for Payer: PHCS Commercial |
$624.96
|
| Rate for Payer: United Healthcare All Payer |
$572.88
|
|
|
REMOVL FORGN BODY VESTBL MOUTH
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
HCPCS 40805
|
| Hospital Charge Code |
76101632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.32 |
| Max. Negotiated Rate |
$1,028.16 |
| Rate for Payer: Aetna Commercial |
$824.67
|
| Rate for Payer: Anthem Medicaid |
$368.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$835.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cash Price |
$535.50
|
| Rate for Payer: Cigna Commercial |
$888.93
|
| Rate for Payer: First Health Commercial |
$1,017.45
|
| Rate for Payer: Humana Commercial |
$910.35
|
| Rate for Payer: Humana KY Medicaid |
$368.32
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$372.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$878.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$790.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$942.48
|
| Rate for Payer: Ohio Health Group HMO |
$803.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.99
|
| Rate for Payer: PHCS Commercial |
$1,028.16
|
| Rate for Payer: United Healthcare All Payer |
$942.48
|
|
