|
REVISION COLOSTOMY HERNIA REPR
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
761P1842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,688.29 |
| Rate for Payer: Aetna Commercial |
$1,688.29
|
| Rate for Payer: Anthem Medicaid |
$538.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,582.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,564.20
|
| Rate for Payer: Healthspan PPO |
$1,423.76
|
| Rate for Payer: Humana Medicaid |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,502.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.26
|
| Rate for Payer: Molina Healthcare Passport |
$538.49
|
| Rate for Payer: Multiplan PHCS |
$949.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,107.40
|
| Rate for Payer: UHCCP Medicaid |
$553.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$543.87
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
76101842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.49 |
| Max. Negotiated Rate |
$1,688.29 |
| Rate for Payer: Aetna Commercial |
$1,688.29
|
| Rate for Payer: Anthem Medicaid |
$538.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,582.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,564.20
|
| Rate for Payer: Healthspan PPO |
$1,423.76
|
| Rate for Payer: Humana Medicaid |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,502.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$549.26
|
| Rate for Payer: Molina Healthcare Passport |
$538.49
|
| Rate for Payer: Multiplan PHCS |
$949.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,107.40
|
| Rate for Payer: UHCCP Medicaid |
$553.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$543.87
|
|
|
REVISION COLOSTOMY HERNIA REPR
|
Facility
|
IP
|
$1,582.00
|
|
|
Service Code
|
HCPCS 44346
|
| Hospital Charge Code |
76101842
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$1,518.72 |
| Rate for Payer: Aetna Commercial |
$1,218.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,233.96
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,313.06
|
| Rate for Payer: First Health Commercial |
$1,502.90
|
| Rate for Payer: Humana Commercial |
$1,344.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.42
|
| Rate for Payer: PHCS Commercial |
$1,518.72
|
| Rate for Payer: United Healthcare All Payer |
$1,392.16
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 57295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
REVISION MASTOIDECTOMY
|
Facility
|
OP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
76102427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem Medicaid |
$962.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| 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 |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Humana KY Medicaid |
$962.92
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$972.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$982.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
REVISION MASTOIDECTOMY
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
76102427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$931.65 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,609.06
|
| Rate for Payer: Anthem Medicaid |
$931.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,581.25
|
| Rate for Payer: Healthspan PPO |
$1,427.31
|
| Rate for Payer: Humana Medicaid |
$931.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,430.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$950.28
|
| Rate for Payer: Molina Healthcare Passport |
$931.65
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$940.97
|
|
|
REVISION MASTOIDECTOMY
|
Facility
|
IP
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
76102427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,688.00 |
| Rate for Payer: Aetna Commercial |
$2,156.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$2,324.00
|
| Rate for Payer: First Health Commercial |
$2,660.00
|
| Rate for Payer: Humana Commercial |
$2,380.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,296.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,066.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$840.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,464.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,100.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$868.00
|
| Rate for Payer: PHCS Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Payer |
$2,464.00
|
|
|
REVISION MASTOIDECTOMY(P
|
Professional
|
Both
|
$2,800.00
|
|
|
Service Code
|
HCPCS 69604
|
| Hospital Charge Code |
761P2427
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$931.65 |
| Max. Negotiated Rate |
$2,800.00 |
| Rate for Payer: Aetna Commercial |
$1,609.06
|
| Rate for Payer: Anthem Medicaid |
$931.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,800.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cash Price |
$1,400.00
|
| Rate for Payer: Cigna Commercial |
$1,581.25
|
| Rate for Payer: Healthspan PPO |
$1,427.31
|
| Rate for Payer: Humana Medicaid |
$931.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,430.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$950.28
|
| Rate for Payer: Molina Healthcare Passport |
$931.65
|
| Rate for Payer: Multiplan PHCS |
$1,680.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,960.00
|
| Rate for Payer: UHCCP Medicaid |
$980.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$940.97
|
|
|
REVISION OF ARM TENDON
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REVISION OF ARM TENDON
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
REVISION OF ARM TENDON
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
76100518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$759.23 |
| Rate for Payer: Aetna Commercial |
$686.18
|
| Rate for Payer: Anthem Medicaid |
$258.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.00
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$759.23
|
| Rate for Payer: Healthspan PPO |
$621.53
|
| Rate for Payer: Humana Medicaid |
$258.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.80
|
| Rate for Payer: Molina Healthcare Passport |
$258.63
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.50
|
| Rate for Payer: UHCCP Medicaid |
$222.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.22
|
|
|
REVISION OF ARM TENDON(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 24310
|
| Hospital Charge Code |
761P0518
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.63 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$686.18
|
| Rate for Payer: Anthem Medicaid |
$258.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$759.23
|
| Rate for Payer: Healthspan PPO |
$621.53
|
| Rate for Payer: Humana Medicaid |
$258.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$263.80
|
| Rate for Payer: Molina Healthcare Passport |
$258.63
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.22
|
|
|
REVISION OF BIG TOE
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
76101008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$549.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.93
|
| Rate for Payer: Anthem Medicaid |
$270.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,430.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$593.93
|
| Rate for Payer: Healthspan PPO |
$669.10
|
| Rate for Payer: Humana Medicaid |
$270.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$439.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.94
|
| Rate for Payer: Molina Healthcare Passport |
$270.53
|
| Rate for Payer: Multiplan PHCS |
$858.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,001.00
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.24
|
|
|
REVISION OF BIG TOE
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
76101008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.90 |
| Max. Negotiated Rate |
$1,372.80 |
| Rate for Payer: Aetna Commercial |
$1,101.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,115.40
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$1,186.90
|
| Rate for Payer: First Health Commercial |
$1,358.50
|
| Rate for Payer: Humana Commercial |
$1,215.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,172.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,055.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$429.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,258.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$443.30
|
| Rate for Payer: PHCS Commercial |
$1,372.80
|
| Rate for Payer: United Healthcare All Payer |
$1,258.40
|
|
|
REVISION OF BIG TOE
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
76101008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.90 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,101.10
|
| Rate for Payer: Anthem Medicaid |
$491.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,115.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$1,186.90
|
| Rate for Payer: First Health Commercial |
$1,358.50
|
| Rate for Payer: Humana Commercial |
$1,215.50
|
| Rate for Payer: Humana KY Medicaid |
$491.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$496.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,172.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,055.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$501.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,258.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,072.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$443.30
|
| Rate for Payer: PHCS Commercial |
$1,372.80
|
| Rate for Payer: United Healthcare All Payer |
$1,258.40
|
|
|
REVISION OF BIG TOE(P
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
HCPCS 28310
|
| Hospital Charge Code |
761P1008
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$549.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.93
|
| Rate for Payer: Anthem Medicaid |
$270.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,430.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cash Price |
$715.00
|
| Rate for Payer: Cigna Commercial |
$593.93
|
| Rate for Payer: Healthspan PPO |
$669.10
|
| Rate for Payer: Humana Medicaid |
$270.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$439.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$275.94
|
| Rate for Payer: Molina Healthcare Passport |
$270.53
|
| Rate for Payer: Multiplan PHCS |
$858.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,001.00
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.24
|
|
|
REVISION OF BLADDER NECK
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
76102112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem Medicaid |
$490.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| 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 |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Humana KY Medicaid |
$490.06
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$495.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$499.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.75
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
REVISION OF BLADDER NECK
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
76102112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.25 |
| Max. Negotiated Rate |
$1,368.00 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,111.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$1,182.75
|
| Rate for Payer: First Health Commercial |
$1,353.75
|
| Rate for Payer: Humana Commercial |
$1,211.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,168.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,051.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,068.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$441.75
|
| Rate for Payer: PHCS Commercial |
$1,368.00
|
| Rate for Payer: United Healthcare All Payer |
$1,254.00
|
|
|
REVISION OF BLADDER NECK
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
76102112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.52 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$791.94
|
| Rate for Payer: Anthem Medicaid |
$446.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,425.00
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$782.14
|
| Rate for Payer: Healthspan PPO |
$633.23
|
| Rate for Payer: Humana Medicaid |
$446.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$663.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$455.45
|
| Rate for Payer: Molina Healthcare Passport |
$446.52
|
| Rate for Payer: Multiplan PHCS |
$855.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$997.50
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.99
|
|
|
REVISION OF BLADDER NECK(P
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
HCPCS 52500
|
| Hospital Charge Code |
761P2112
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$446.52 |
| Max. Negotiated Rate |
$1,425.00 |
| Rate for Payer: Aetna Commercial |
$791.94
|
| Rate for Payer: Anthem Medicaid |
$446.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,425.00
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cash Price |
$712.50
|
| Rate for Payer: Cigna Commercial |
$782.14
|
| Rate for Payer: Healthspan PPO |
$633.23
|
| Rate for Payer: Humana Medicaid |
$446.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$663.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$455.45
|
| Rate for Payer: Molina Healthcare Passport |
$446.52
|
| Rate for Payer: Multiplan PHCS |
$855.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$997.50
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.99
|
|
|
REVISION OF CERVIX
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 57720
|
| Hospital Charge Code |
76102690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$535.00 |
| Rate for Payer: Aetna Commercial |
$457.50
|
| Rate for Payer: Anthem Medicaid |
$199.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$535.00
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$447.62
|
| Rate for Payer: Healthspan PPO |
$442.97
|
| Rate for Payer: Humana Medicaid |
$199.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$396.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$203.73
|
| Rate for Payer: Molina Healthcare Passport |
$199.74
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$374.50
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.74
|
|
|
REVISION OF COLLAR BONE
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
76100469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$511.41 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna Commercial |
$1,217.12
|
| Rate for Payer: Anthem Medicaid |
$511.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,675.00
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,335.84
|
| Rate for Payer: Healthspan PPO |
$1,102.45
|
| Rate for Payer: Humana Medicaid |
$511.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,019.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$521.64
|
| Rate for Payer: Molina Healthcare Passport |
$511.41
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,172.50
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$516.52
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
76100469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$502.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.25
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
76100469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.75 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem Medicaid |
$576.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,390.25
|
| Rate for Payer: First Health Commercial |
$1,591.25
|
| Rate for Payer: Humana Commercial |
$1,423.75
|
| Rate for Payer: Humana KY Medicaid |
$576.03
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$581.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,373.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,236.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$587.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,474.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,256.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$335.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$519.25
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
REVISION OF COLLAR BONE(P
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
761P0469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$511.41 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna Commercial |
$1,217.12
|
| Rate for Payer: Anthem Medicaid |
$511.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,675.00
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cash Price |
$837.50
|
| Rate for Payer: Cigna Commercial |
$1,335.84
|
| Rate for Payer: Healthspan PPO |
$1,102.45
|
| Rate for Payer: Humana Medicaid |
$511.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,019.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$521.64
|
| Rate for Payer: Molina Healthcare Passport |
$511.41
|
| Rate for Payer: Multiplan PHCS |
$1,005.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,172.50
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$516.52
|
|
