|
REPAIR LUMBAR HERNIA
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$1,012.80 |
| Rate for Payer: Aetna Commercial |
$967.13
|
| Rate for Payer: Ambetter Exchange |
$644.54
|
| Rate for Payer: Anthem Medicaid |
$398.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$644.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$644.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$773.45
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$904.09
|
| Rate for Payer: Healthspan PPO |
$815.60
|
| Rate for Payer: Humana Medicaid |
$398.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$856.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$644.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$644.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.78
|
| Rate for Payer: Molina Healthcare Passport |
$398.80
|
| Rate for Payer: Multiplan PHCS |
$1,012.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$837.90
|
| Rate for Payer: UHCCP Medicaid |
$590.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$644.54
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$580.50 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,299.76
|
| Rate for Payer: Anthem Medicaid |
$580.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.64
|
| 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 |
$844.00
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$1,401.04
|
| Rate for Payer: First Health Commercial |
$1,603.60
|
| Rate for Payer: Humana Commercial |
$1,434.80
|
| Rate for Payer: Humana KY Medicaid |
$580.50
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$586.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,384.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,266.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,468.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.72
|
| Rate for Payer: PHCS Commercial |
$1,620.48
|
| Rate for Payer: United Healthcare All Payer |
$1,485.44
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49540
|
| Hospital Charge Code |
76102904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.40 |
| Max. Negotiated Rate |
$1,620.48 |
| Rate for Payer: Aetna Commercial |
$1,299.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.64
|
| Rate for Payer: Cash Price |
$844.00
|
| Rate for Payer: Cigna Commercial |
$1,401.04
|
| Rate for Payer: First Health Commercial |
$1,603.60
|
| Rate for Payer: Humana Commercial |
$1,434.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,384.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,266.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,350.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,468.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.72
|
| Rate for Payer: PHCS Commercial |
$1,620.48
|
| Rate for Payer: United Healthcare All Payer |
$1,485.44
|
|
|
REPAIR LUMBAR HERNIA
|
Facility
|
OP
|
$7,547.16
|
|
|
Service Code
|
CPT 49540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,390.83 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
|
|
REPAIR LUNG HERNIA CHEST WALL
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
76101231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPAIR LUNG HERNIA CHEST WALL
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
76101231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REPAIR LUNG HERNIA CHEST WALL
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
76101231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.54 |
| Max. Negotiated Rate |
$1,551.72 |
| Rate for Payer: Aetna Commercial |
$1,551.72
|
| Rate for Payer: Ambetter Exchange |
$894.43
|
| Rate for Payer: Anthem Medicaid |
$615.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$894.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$894.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,073.32
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,461.65
|
| Rate for Payer: Healthspan PPO |
$1,211.54
|
| Rate for Payer: Humana Medicaid |
$615.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,295.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$894.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$627.85
|
| Rate for Payer: Molina Healthcare Passport |
$615.54
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,162.76
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$621.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$894.43
|
|
|
REPAIR LUNG HERNIA CHEST WAL(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32800
|
| Hospital Charge Code |
761P1231
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.54 |
| Max. Negotiated Rate |
$1,551.72 |
| Rate for Payer: Aetna Commercial |
$1,551.72
|
| Rate for Payer: Ambetter Exchange |
$894.43
|
| Rate for Payer: Anthem Medicaid |
$615.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$894.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$894.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,073.32
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,461.65
|
| Rate for Payer: Healthspan PPO |
$1,211.54
|
| Rate for Payer: Humana Medicaid |
$615.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,295.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$894.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$894.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$627.85
|
| Rate for Payer: Molina Healthcare Passport |
$615.54
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,162.76
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$621.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$894.43
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 54408
|
| Hospital Charge Code |
76102870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$1,282.22 |
| Rate for Payer: Aetna Commercial |
$1,282.22
|
| Rate for Payer: Ambetter Exchange |
$748.93
|
| Rate for Payer: Anthem Medicaid |
$553.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$748.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$748.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$898.72
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,132.51
|
| Rate for Payer: Healthspan PPO |
$1,241.52
|
| Rate for Payer: Humana Medicaid |
$553.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,077.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$748.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$748.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.75
|
| Rate for Payer: Molina Healthcare Passport |
$553.68
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$973.61
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$559.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$748.93
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS 54408
|
| Hospital Charge Code |
76102870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$6,576.02 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,697.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,576.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,341.17
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Humana Medicare Advantage |
$4,697.16
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REPAIR MULTI-COMP PENIS PROS
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS 54408
|
| Hospital Charge Code |
76102870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
REPAIR MV
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
76101290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPAIR MV
|
Facility
|
OP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
76101290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem Medicaid |
$1,891.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Humana KY Medicaid |
$1,891.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,910.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,929.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,785.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,795.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
REPAIR MV
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
76101290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,763.15 |
| Max. Negotiated Rate |
$4,060.67 |
| Rate for Payer: Aetna Commercial |
$4,060.67
|
| Rate for Payer: Ambetter Exchange |
$2,237.96
|
| Rate for Payer: Anthem Medicaid |
$1,763.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,237.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,237.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,685.55
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,810.98
|
| Rate for Payer: Healthspan PPO |
$3,992.42
|
| Rate for Payer: Humana Medicaid |
$1,763.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,382.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,237.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,798.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,763.15
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,909.35
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,780.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,237.96
|
|
|
REPAIR MV(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 33426
|
| Hospital Charge Code |
761P1290
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,763.15 |
| Max. Negotiated Rate |
$4,060.67 |
| Rate for Payer: Aetna Commercial |
$4,060.67
|
| Rate for Payer: Ambetter Exchange |
$2,237.96
|
| Rate for Payer: Anthem Medicaid |
$1,763.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2,237.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,237.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,685.55
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$3,810.98
|
| Rate for Payer: Healthspan PPO |
$3,992.42
|
| Rate for Payer: Humana Medicaid |
$1,763.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,382.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2,237.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,237.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,798.41
|
| Rate for Payer: Molina Healthcare Passport |
$1,763.15
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,909.35
|
| Rate for Payer: UHCCP Medicaid |
$1,925.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,780.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$2,237.96
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
76101135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$435.00 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
76101135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$498.65 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.65
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,261.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
REPAIR NASAL SEPTUM DEFECT
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
76101135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.04 |
| Max. Negotiated Rate |
$877.01 |
| Rate for Payer: Aetna Commercial |
$877.01
|
| Rate for Payer: Ambetter Exchange |
$616.33
|
| Rate for Payer: Anthem Medicaid |
$385.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.60
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$865.33
|
| Rate for Payer: Healthspan PPO |
$739.60
|
| Rate for Payer: Humana Medicaid |
$385.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$790.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$616.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.74
|
| Rate for Payer: Molina Healthcare Passport |
$385.04
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$801.23
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.33
|
|
|
REPAIR NASAL SEPTUM DEFECT(P
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 30630
|
| Hospital Charge Code |
761P1135
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.04 |
| Max. Negotiated Rate |
$877.01 |
| Rate for Payer: Aetna Commercial |
$877.01
|
| Rate for Payer: Ambetter Exchange |
$616.33
|
| Rate for Payer: Anthem Medicaid |
$385.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$616.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$616.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$739.60
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$865.33
|
| Rate for Payer: Healthspan PPO |
$739.60
|
| Rate for Payer: Humana Medicaid |
$385.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$790.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$616.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.74
|
| Rate for Payer: Molina Healthcare Passport |
$385.04
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$801.23
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$388.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$616.33
|
|
|
REPAIR NASAL STENOSIS
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
76101131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,652.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,379.03
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR NASAL STENOSIS
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
76101131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REPAIR NASAL STENOSIS
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
76101131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,390.46 |
| Rate for Payer: Aetna Commercial |
$1,390.46
|
| Rate for Payer: Ambetter Exchange |
$948.56
|
| Rate for Payer: Anthem Medicaid |
$590.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$948.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$948.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,138.27
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,381.41
|
| Rate for Payer: Healthspan PPO |
$1,172.60
|
| Rate for Payer: Humana Medicaid |
$590.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,246.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$948.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$602.72
|
| Rate for Payer: Molina Healthcare Passport |
$590.90
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,233.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$596.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$948.56
|
|
|
REPAIR NASAL STENOSIS(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 30465
|
| Hospital Charge Code |
761P1131
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,390.46 |
| Rate for Payer: Aetna Commercial |
$1,390.46
|
| Rate for Payer: Ambetter Exchange |
$948.56
|
| Rate for Payer: Anthem Medicaid |
$590.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$948.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$948.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,138.27
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,381.41
|
| Rate for Payer: Healthspan PPO |
$1,172.60
|
| Rate for Payer: Humana Medicaid |
$590.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,246.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$948.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$602.72
|
| Rate for Payer: Molina Healthcare Passport |
$590.90
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,233.13
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$596.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$948.56
|
|
|
REPAIR NON/MALU HUM WO GRAFT
|
Facility
|
IP
|
$2,400.00
|
|
|
Service Code
|
HCPCS 24430
|
| Hospital Charge Code |
76100530
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,848.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,872.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cigna Commercial |
$1,992.00
|
| Rate for Payer: First Health Commercial |
$2,280.00
|
| Rate for Payer: Humana Commercial |
$2,040.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,968.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,771.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$720.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,112.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,088.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,656.00
|
| Rate for Payer: PHCS Commercial |
$2,304.00
|
| Rate for Payer: United Healthcare All Payer |
$2,112.00
|
|
