|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$40,783.46
|
|
|
Service Code
|
MSDRG 467
|
| Min. Negotiated Rate |
$27,674.49 |
| Max. Negotiated Rate |
$40,783.46 |
| Rate for Payer: Anthem Medicaid |
$27,674.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$29,131.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$40,783.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$39,326.90
|
| Rate for Payer: Humana KY Medicaid |
$27,674.49
|
| Rate for Payer: Humana Medicare Advantage |
$29,131.04
|
| Rate for Payer: Kentucky WC Medicaid |
$27,951.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34,957.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,227.98
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$60,673.91
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$41,171.58 |
| Max. Negotiated Rate |
$60,673.91 |
| Rate for Payer: Anthem Medicaid |
$41,171.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43,338.51
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$60,673.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$58,506.99
|
| Rate for Payer: Humana KY Medicaid |
$41,171.58
|
| Rate for Payer: Humana Medicare Advantage |
$43,338.51
|
| Rate for Payer: Kentucky WC Medicaid |
$41,583.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52,006.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$41,995.02
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$31,229.53
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$21,191.47 |
| Max. Negotiated Rate |
$31,229.53 |
| Rate for Payer: Anthem Medicaid |
$21,191.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,306.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31,229.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,114.19
|
| Rate for Payer: Humana KY Medicaid |
$21,191.47
|
| Rate for Payer: Humana Medicare Advantage |
$22,306.81
|
| Rate for Payer: Kentucky WC Medicaid |
$21,403.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,768.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,615.30
|
|
|
REVISION OF ILEOSTOMY
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 44314
|
| Hospital Charge Code |
76102773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,454.92 |
| Rate for Payer: Aetna Commercial |
$1,454.92
|
| Rate for Payer: Anthem Medicaid |
$495.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,040.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$1,346.83
|
| Rate for Payer: Healthspan PPO |
$1,226.96
|
| Rate for Payer: Humana Medicaid |
$495.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,284.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.17
|
| Rate for Payer: Molina Healthcare Passport |
$495.26
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$728.00
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.21
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
76100848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.30 |
| Max. Negotiated Rate |
$6,825.60 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,545.80
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$5,901.30
|
| Rate for Payer: First Health Commercial |
$6,754.50
|
| Rate for Payer: Humana Commercial |
$6,043.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,256.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.10
|
| Rate for Payer: PHCS Commercial |
$6,825.60
|
| Rate for Payer: United Healthcare All Payer |
$6,256.80
|
|
|
REVISION OF KNEE JOINT
|
Professional
|
Both
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
76100848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.39 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$1,678.70
|
| Rate for Payer: Anthem Medicaid |
$1,051.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,110.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$1,829.63
|
| Rate for Payer: Healthspan PPO |
$1,520.54
|
| Rate for Payer: Humana Medicaid |
$1,051.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,389.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,072.42
|
| Rate for Payer: Molina Healthcare Passport |
$1,051.39
|
| Rate for Payer: Multiplan PHCS |
$4,266.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,977.00
|
| Rate for Payer: UHCCP Medicaid |
$2,488.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,061.90
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
76100848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$924.30 |
| Max. Negotiated Rate |
$15,933.60 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Anthem Medicaid |
$2,445.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,381.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,545.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,933.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,364.54
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$5,901.30
|
| Rate for Payer: First Health Commercial |
$6,754.50
|
| Rate for Payer: Humana Commercial |
$6,043.50
|
| Rate for Payer: Humana KY Medicaid |
$2,445.13
|
| Rate for Payer: Humana Medicare Advantage |
$11,381.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,657.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,256.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,422.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$924.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,204.10
|
| Rate for Payer: PHCS Commercial |
$6,825.60
|
| Rate for Payer: United Healthcare All Payer |
$6,256.80
|
|
|
REVISION OF KNEE JOINT(P
|
Professional
|
Both
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
761P0848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.39 |
| Max. Negotiated Rate |
$7,110.00 |
| Rate for Payer: Aetna Commercial |
$1,678.70
|
| Rate for Payer: Anthem Medicaid |
$1,051.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,110.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$1,829.63
|
| Rate for Payer: Healthspan PPO |
$1,520.54
|
| Rate for Payer: Humana Medicaid |
$1,051.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,389.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,072.42
|
| Rate for Payer: Molina Healthcare Passport |
$1,051.39
|
| Rate for Payer: Multiplan PHCS |
$4,266.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,977.00
|
| Rate for Payer: UHCCP Medicaid |
$2,488.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,061.90
|
|
|
REVISION OF LOWER LEG TENDON
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
76100912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| 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 |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REVISION OF LOWER LEG TENDON
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
76100912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$705.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.92
|
| Rate for Payer: Anthem Medicaid |
$291.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$784.46
|
| Rate for Payer: Healthspan PPO |
$808.94
|
| Rate for Payer: Humana Medicaid |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$578.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.92
|
| Rate for Payer: Molina Healthcare Passport |
$291.10
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$249.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.01
|
|
|
REVISION OF LOWER LEG TENDON
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
76100912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$210.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$325.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REVISION OF LOWER LEG TENDO(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
761P0912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$705.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.92
|
| Rate for Payer: Anthem Medicaid |
$291.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,050.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$784.46
|
| Rate for Payer: Healthspan PPO |
$808.94
|
| Rate for Payer: Humana Medicaid |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$578.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.92
|
| Rate for Payer: Molina Healthcare Passport |
$291.10
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$735.00
|
| Rate for Payer: UHCCP Medicaid |
$249.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.01
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
76102622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
76102622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$214.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
REVISION OF NOSE
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
76102622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.86 |
| Max. Negotiated Rate |
$693.25 |
| Rate for Payer: Aetna Commercial |
$636.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.86
|
| Rate for Payer: Anthem Medicaid |
$351.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$693.25
|
| Rate for Payer: Healthspan PPO |
$608.85
|
| Rate for Payer: Humana Medicaid |
$351.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.92
|
| Rate for Payer: Molina Healthcare Passport |
$351.88
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$237.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.40
|
|
|
REVISION OF NOSE
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
761P2622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.86 |
| Max. Negotiated Rate |
$693.25 |
| Rate for Payer: Aetna Commercial |
$636.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.86
|
| Rate for Payer: Anthem Medicaid |
$351.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$693.25
|
| Rate for Payer: Healthspan PPO |
$608.85
|
| Rate for Payer: Humana Medicaid |
$351.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.92
|
| Rate for Payer: Molina Healthcare Passport |
$351.88
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$237.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.40
|
|
|
REVISION OF PENIS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 54435
|
| Hospital Charge Code |
76102845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REVISION OF PENIS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 54435
|
| Hospital Charge Code |
76102845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| 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 |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$133.30
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REVISION OF PENIS
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 54435
|
| Hospital Charge Code |
76102845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$673.83 |
| Rate for Payer: Aetna Commercial |
$673.83
|
| Rate for Payer: Anthem Medicaid |
$285.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$430.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$598.75
|
| Rate for Payer: Healthspan PPO |
$652.44
|
| Rate for Payer: Humana Medicaid |
$285.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.71
|
| Rate for Payer: Molina Healthcare Passport |
$285.99
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$301.00
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.85
|
|
|
REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY
|
Facility
|
OP
|
$4,614.69
|
|
|
Service Code
|
CPT 19370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,296.21 |
| Max. Negotiated Rate |
$4,614.69 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,296.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,614.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,449.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,296.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,955.45
|
|
|
REVISION OF PERITONEAL-VENOUS SHUNT
|
Facility
|
OP
|
$4,188.46
|
|
|
Service Code
|
CPT 49426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,991.76 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
|
|
REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEMENT AND/OR RE-INSET OF FLAPS IN AUTOLOGOUS RECONSTRUCTION OR SIGNIFICANT CAPSULAR REVISION COMBINED WITH SOFT TISSUE EXCISION IN IMPLANT-BASED RECONSTRUCTION)
|
Facility
|
OP
|
$7,894.80
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,639.14 |
| Max. Negotiated Rate |
$7,894.80 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,639.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,894.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,612.84
|
| Rate for Payer: Humana Medicare Advantage |
$5,639.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,766.97
|
|
|
REVISION OF TIPS
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
76101524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.35
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
REVISION OF TIPS
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
76101524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.96 |
| Max. Negotiated Rate |
$672.44 |
| Rate for Payer: Aetna Commercial |
$672.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$243.96
|
| Rate for Payer: Anthem Medicaid |
$321.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$585.00
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$610.50
|
| Rate for Payer: Healthspan PPO |
$537.68
|
| Rate for Payer: Humana Medicaid |
$321.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$520.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.02
|
| Rate for Payer: Molina Healthcare Passport |
$321.59
|
| Rate for Payer: Multiplan PHCS |
$351.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.50
|
| Rate for Payer: UHCCP Medicaid |
$256.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$324.81
|
|
|
REVISION OF TIPS
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
HCPCS 37183
|
| Hospital Charge Code |
76101524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.05 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem Medicaid |
$201.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Humana KY Medicaid |
$201.18
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$203.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.35
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
