|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
76102433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,117.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,154.75
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 69643
|
| Hospital Charge Code |
76102434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,003.84 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna Commercial |
$1,754.67
|
| Rate for Payer: Anthem Medicaid |
$1,003.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$1,726.68
|
| Rate for Payer: Healthspan PPO |
$1,556.48
|
| Rate for Payer: Humana Medicaid |
$1,003.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,566.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,023.92
|
| Rate for Payer: Molina Healthcare Passport |
$1,003.84
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,013.88
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69645
|
| Hospital Charge Code |
76102435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$3,576.00 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,117.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,154.75
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69645
|
| Hospital Charge Code |
76102435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,067.22 |
| Max. Negotiated Rate |
$3,725.00 |
| Rate for Payer: Aetna Commercial |
$2,071.41
|
| Rate for Payer: Anthem Medicaid |
$1,067.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,725.00
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$2,072.58
|
| Rate for Payer: Healthspan PPO |
$1,837.44
|
| Rate for Payer: Humana Medicaid |
$1,067.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,855.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,088.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,067.22
|
| Rate for Payer: Multiplan PHCS |
$2,235.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,607.50
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,077.89
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69645
|
| Hospital Charge Code |
76102435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.25 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$3,091.75
|
| Rate for Payer: First Health Commercial |
$3,538.75
|
| Rate for Payer: Humana Commercial |
$3,166.25
|
| Rate for Payer: Humana KY Medicaid |
$1,281.03
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,054.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,749.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,306.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,278.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,793.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,154.75
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
REVISE MIDDLE EAR & MASTOID(P
|
Professional
|
Both
|
$3,800.00
|
|
|
Service Code
|
HCPCS 69643
|
| Hospital Charge Code |
761P2434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,003.84 |
| Max. Negotiated Rate |
$3,800.00 |
| Rate for Payer: Aetna Commercial |
$1,754.67
|
| Rate for Payer: Anthem Medicaid |
$1,003.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,800.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$1,726.68
|
| Rate for Payer: Healthspan PPO |
$1,556.48
|
| Rate for Payer: Humana Medicaid |
$1,003.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,566.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,023.92
|
| Rate for Payer: Molina Healthcare Passport |
$1,003.84
|
| Rate for Payer: Multiplan PHCS |
$2,280.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,660.00
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,013.88
|
|
|
REVISE MIDDLE EAR & MASTOID(P
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
761P2433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.98 |
| Max. Negotiated Rate |
$3,725.00 |
| Rate for Payer: Aetna Commercial |
$1,487.59
|
| Rate for Payer: Anthem Medicaid |
$827.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,725.00
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$1,460.40
|
| Rate for Payer: Healthspan PPO |
$1,319.56
|
| Rate for Payer: Humana Medicaid |
$827.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,331.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$844.54
|
| Rate for Payer: Molina Healthcare Passport |
$827.98
|
| Rate for Payer: Multiplan PHCS |
$2,235.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,607.50
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$836.26
|
|
|
REVISE MIDDLE EAR & MASTOID(P
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69645
|
| Hospital Charge Code |
761P2435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,067.22 |
| Max. Negotiated Rate |
$3,725.00 |
| Rate for Payer: Aetna Commercial |
$2,071.41
|
| Rate for Payer: Anthem Medicaid |
$1,067.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,725.00
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,862.50
|
| Rate for Payer: Cigna Commercial |
$2,072.58
|
| Rate for Payer: Healthspan PPO |
$1,837.44
|
| Rate for Payer: Humana Medicaid |
$1,067.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,855.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,088.56
|
| Rate for Payer: Molina Healthcare Passport |
$1,067.22
|
| Rate for Payer: Multiplan PHCS |
$2,235.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,607.50
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,077.89
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
76102338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
76102338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$253.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.02
|
| Rate for Payer: Anthem Medicaid |
$87.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$251.33
|
| Rate for Payer: Healthspan PPO |
$397.63
|
| Rate for Payer: Humana Medicaid |
$87.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$192.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.92
|
| Rate for Payer: Molina Healthcare Passport |
$87.18
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.05
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
76102338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.75 |
| Max. Negotiated Rate |
$4,119.29 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,942.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,119.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,972.17
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$643.25
|
| Rate for Payer: First Health Commercial |
$736.25
|
| Rate for Payer: Humana Commercial |
$658.75
|
| Rate for Payer: Humana KY Medicaid |
$266.52
|
| Rate for Payer: Humana Medicare Advantage |
$2,942.35
|
| Rate for Payer: Kentucky WC Medicaid |
$269.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$571.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$271.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.00
|
| Rate for Payer: Ohio Health Group HMO |
$581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.25
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
REVISE/REMOVE NEUROELECTROD(P
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
761P2338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.02 |
| Max. Negotiated Rate |
$775.00 |
| Rate for Payer: Aetna Commercial |
$253.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.02
|
| Rate for Payer: Anthem Medicaid |
$87.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$251.33
|
| Rate for Payer: Healthspan PPO |
$397.63
|
| Rate for Payer: Humana Medicaid |
$87.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$192.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.92
|
| Rate for Payer: Molina Healthcare Passport |
$87.18
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.05
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
76102309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$1,176.00 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.75
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
76102309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.20 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna Commercial |
$572.09
|
| Rate for Payer: Anthem Medicaid |
$334.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.00
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$595.69
|
| Rate for Payer: Healthspan PPO |
$446.67
|
| Rate for Payer: Humana Medicaid |
$334.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$460.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.88
|
| Rate for Payer: Molina Healthcare Passport |
$334.20
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.54
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
76102309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$4,119.29 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,942.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,119.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,972.17
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$1,016.75
|
| Rate for Payer: First Health Commercial |
$1,163.75
|
| Rate for Payer: Humana Commercial |
$1,041.25
|
| Rate for Payer: Humana KY Medicaid |
$421.28
|
| Rate for Payer: Humana Medicare Advantage |
$2,942.35
|
| Rate for Payer: Kentucky WC Medicaid |
$425.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,004.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$904.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$429.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,078.00
|
| Rate for Payer: Ohio Health Group HMO |
$918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.75
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
REVISE/REMOVE NEURORECEIVER(P
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
761P2309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.20 |
| Max. Negotiated Rate |
$1,225.00 |
| Rate for Payer: Aetna Commercial |
$572.09
|
| Rate for Payer: Anthem Medicaid |
$334.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,225.00
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cash Price |
$612.50
|
| Rate for Payer: Cigna Commercial |
$595.69
|
| Rate for Payer: Healthspan PPO |
$446.67
|
| Rate for Payer: Humana Medicaid |
$334.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$460.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$340.88
|
| Rate for Payer: Molina Healthcare Passport |
$334.20
|
| Rate for Payer: Multiplan PHCS |
$735.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$857.50
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.54
|
|
|
REVISE/RMV PN/GASTR STIMUL
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
76102340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$224.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.54
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$222.46
|
| Rate for Payer: Healthspan PPO |
$384.57
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$67.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
|
|
REVISE/RMV PN/GASTR STIMUL
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
76102340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REVISE/RMV PN/GASTR STIMUL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
76102340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$4,119.29 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,942.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,119.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,972.17
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,942.35
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,530.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
REVISE/RMV PN/GASTR STIMUL(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
761P2340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$224.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.54
|
| Rate for Payer: Anthem Medicaid |
$84.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$222.46
|
| Rate for Payer: Healthspan PPO |
$384.57
|
| Rate for Payer: Humana Medicaid |
$84.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.13
|
| Rate for Payer: Molina Healthcare Passport |
$84.44
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$67.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
76102933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.19 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$664.51
|
| Rate for Payer: Anthem Medicaid |
$296.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$716.29
|
| Rate for Payer: First Health Commercial |
$819.85
|
| Rate for Payer: Humana Commercial |
$733.55
|
| Rate for Payer: Humana KY Medicaid |
$296.79
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$299.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$707.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$759.44
|
| Rate for Payer: Ohio Health Group HMO |
$647.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.53
|
| Rate for Payer: PHCS Commercial |
$828.48
|
| Rate for Payer: United Healthcare All Payer |
$759.44
|
|
|
REVISE SPERMATIC CORD VEINS
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
76102933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.19 |
| Max. Negotiated Rate |
$828.48 |
| Rate for Payer: Aetna Commercial |
$664.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$673.14
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$716.29
|
| Rate for Payer: First Health Commercial |
$819.85
|
| Rate for Payer: Humana Commercial |
$733.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$707.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$759.44
|
| Rate for Payer: Ohio Health Group HMO |
$647.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.53
|
| Rate for Payer: PHCS Commercial |
$828.48
|
| Rate for Payer: United Healthcare All Payer |
$759.44
|
|
|
REVISE SPERMATIC CORD VEINS
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 55530
|
| Hospital Charge Code |
76102933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.05 |
| Max. Negotiated Rate |
$863.00 |
| Rate for Payer: Aetna Commercial |
$571.94
|
| Rate for Payer: Anthem Medicaid |
$313.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$863.00
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cash Price |
$431.50
|
| Rate for Payer: Cigna Commercial |
$509.76
|
| Rate for Payer: Healthspan PPO |
$553.78
|
| Rate for Payer: Humana Medicaid |
$313.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$481.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.26
|
| Rate for Payer: Molina Healthcare Passport |
$313.98
|
| Rate for Payer: Multiplan PHCS |
$517.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$604.10
|
| Rate for Payer: UHCCP Medicaid |
$302.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.12
|
|
|
REVISE SPINE ELTRD PERQ ARA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
761P2307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$229.44 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$786.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$229.44
|
| Rate for Payer: Anthem Medicaid |
$346.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$768.67
|
| Rate for Payer: Healthspan PPO |
$808.92
|
| Rate for Payer: Humana Medicaid |
$346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$613.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.59
|
| Rate for Payer: Molina Healthcare Passport |
$346.66
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$240.91
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.13
|
|
|
REVISE SPINE ELTRD PERQ ARAY
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 63663
|
| Hospital Charge Code |
76102307
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
