|
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 |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,754.67
|
| Rate for Payer: Ambetter Exchange |
$1,132.87
|
| Rate for Payer: Anthem Medicaid |
$1,003.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,132.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,132.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,359.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,132.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.87
|
| 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 |
$1,472.73
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,013.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,132.87
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
76102433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,117.50 |
| 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 |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
76102433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,281.03 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| 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 |
$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 |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.07
|
| 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 |
$6,559.14
|
| 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 |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| Rate for Payer: PHCS Commercial |
$3,576.00
|
| Rate for Payer: United Healthcare All Payer |
$3,278.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69645
|
| Hospital Charge Code |
76102435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,281.03 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,868.25
|
| Rate for Payer: Anthem Medicaid |
$1,281.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,905.50
|
| 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 |
$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 |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,294.07
|
| 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 |
$6,559.14
|
| 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 |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| 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 |
$2,235.00 |
| Rate for Payer: Aetna Commercial |
$2,071.41
|
| Rate for Payer: Ambetter Exchange |
$1,367.95
|
| Rate for Payer: Anthem Medicaid |
$1,067.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,367.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,367.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,641.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,367.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.95
|
| 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 |
$1,778.34
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,077.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,367.95
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Professional
|
Both
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69641
|
| Hospital Charge Code |
76102433
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$827.98 |
| Max. Negotiated Rate |
$2,235.00 |
| Rate for Payer: Aetna Commercial |
$1,487.59
|
| Rate for Payer: Ambetter Exchange |
$964.25
|
| Rate for Payer: Anthem Medicaid |
$827.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$964.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$964.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,157.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$964.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.25
|
| 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 |
$1,253.53
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$836.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$964.25
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 69643
|
| Hospital Charge Code |
76102434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,306.82 |
| Max. Negotiated Rate |
$7,652.33 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem Medicaid |
$1,306.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,465.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| 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 |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Humana KY Medicaid |
$1,306.82
|
| Rate for Payer: Humana Medicare Advantage |
$5,465.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,559.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
HCPCS 69643
|
| Hospital Charge Code |
76102434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,140.00 |
| Max. Negotiated Rate |
$3,648.00 |
| Rate for Payer: Aetna Commercial |
$2,926.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,964.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cigna Commercial |
$3,154.00
|
| Rate for Payer: First Health Commercial |
$3,610.00
|
| Rate for Payer: Humana Commercial |
$3,230.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,116.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,804.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,344.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,850.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,306.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,622.00
|
| Rate for Payer: PHCS Commercial |
$3,648.00
|
| Rate for Payer: United Healthcare All Payer |
$3,344.00
|
|
|
REVISE MIDDLE EAR & MASTOID
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
HCPCS 69645
|
| Hospital Charge Code |
76102435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,117.50 |
| 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 |
$2,980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,240.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,570.25
|
| 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 |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$1,754.67
|
| Rate for Payer: Ambetter Exchange |
$1,132.87
|
| Rate for Payer: Anthem Medicaid |
$1,003.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,132.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,132.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,359.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,132.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.87
|
| 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 |
$1,472.73
|
| Rate for Payer: UHCCP Medicaid |
$1,330.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,013.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,132.87
|
|
|
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 |
$2,235.00 |
| Rate for Payer: Aetna Commercial |
$2,071.41
|
| Rate for Payer: Ambetter Exchange |
$1,367.95
|
| Rate for Payer: Anthem Medicaid |
$1,067.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,367.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,367.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,641.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,367.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,367.95
|
| 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 |
$1,778.34
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,077.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,367.95
|
|
|
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 |
$2,235.00 |
| Rate for Payer: Aetna Commercial |
$1,487.59
|
| Rate for Payer: Ambetter Exchange |
$964.25
|
| Rate for Payer: Anthem Medicaid |
$827.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$964.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$964.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,157.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$964.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.25
|
| 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 |
$1,253.53
|
| Rate for Payer: UHCCP Medicaid |
$1,303.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$836.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$964.25
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
OP
|
$775.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
76102338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$4,448.61 |
| Rate for Payer: Aetna Commercial |
$596.75
|
| Rate for Payer: Anthem Medicaid |
$266.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,177.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,448.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,289.73
|
| 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 |
$3,177.58
|
| 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 |
$3,813.10
|
| 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 |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| Rate for Payer: PHCS Commercial |
$744.00
|
| Rate for Payer: United Healthcare All Payer |
$682.00
|
|
|
REVISE/REMOVE NEUROELECTRODE
|
Facility
|
IP
|
$775.00
|
|
|
Service Code
|
HCPCS 64585
|
| Hospital Charge Code |
76102338
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.50 |
| 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 |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.75
|
| 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 |
$465.00 |
| Rate for Payer: Aetna Commercial |
$253.76
|
| Rate for Payer: Ambetter Exchange |
$135.40
|
| 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 Individual/Medicaid |
$135.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$162.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$135.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.40
|
| 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 |
$176.02
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.40
|
|
|
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 |
$465.00 |
| Rate for Payer: Aetna Commercial |
$253.76
|
| Rate for Payer: Ambetter Exchange |
$135.40
|
| 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 Individual/Medicaid |
$135.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$162.48
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$135.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.40
|
| 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 |
$176.02
|
| Rate for Payer: UHCCP Medicaid |
$76.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.40
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
OP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
76102309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.28 |
| Max. Negotiated Rate |
$4,448.61 |
| Rate for Payer: Aetna Commercial |
$943.25
|
| Rate for Payer: Anthem Medicaid |
$421.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,177.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$955.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,448.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,289.73
|
| 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 |
$3,177.58
|
| 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 |
$3,813.10
|
| 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 |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| Rate for Payer: PHCS Commercial |
$1,176.00
|
| Rate for Payer: United Healthcare All Payer |
$1,078.00
|
|
|
REVISE/REMOVE NEURORECEIVER
|
Facility
|
IP
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
76102309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.50 |
| 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 |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,065.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$845.25
|
| 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 |
$284.55 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$572.09
|
| Rate for Payer: Ambetter Exchange |
$284.55
|
| Rate for Payer: Anthem Medicaid |
$334.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$284.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$284.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$341.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$284.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.55
|
| 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 |
$369.92
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$284.55
|
|
|
REVISE/REMOVE NEURORECEIVER(P
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 63688
|
| Hospital Charge Code |
761P2309
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.55 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$572.09
|
| Rate for Payer: Ambetter Exchange |
$284.55
|
| Rate for Payer: Anthem Medicaid |
$334.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$284.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$284.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$341.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$284.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.55
|
| 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 |
$369.92
|
| Rate for Payer: UHCCP Medicaid |
$428.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$284.55
|
|
|
REVISE/REMOVE SLING REPAIR
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57287
|
| Hospital Charge Code |
76102971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REVISE/REMOVE SLING REPAIR
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57287
|
| Hospital Charge Code |
76102971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.02 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$900.00
|
| 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: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| 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 |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| 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 |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REVISE/REMOVE SLING REPAIR
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57287
|
| Hospital Charge Code |
76102971
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$505.43 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$1,053.84
|
| Rate for Payer: Ambetter Exchange |
$697.00
|
| Rate for Payer: Anthem Medicaid |
$505.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$697.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$697.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$836.40
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,002.33
|
| Rate for Payer: Healthspan PPO |
$1,020.38
|
| Rate for Payer: Humana Medicaid |
$505.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$887.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$697.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$515.54
|
| Rate for Payer: Molina Healthcare Passport |
$505.43
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$906.10
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$510.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$697.00
|
|
|
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 |
$420.00 |
| Rate for Payer: Aetna Commercial |
$224.31
|
| Rate for Payer: Ambetter Exchange |
$217.59
|
| 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 Individual/Medicaid |
$217.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$217.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$261.11
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$217.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.59
|
| 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 |
$282.87
|
| Rate for Payer: UHCCP Medicaid |
$67.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$217.59
|
|
|
REVISE/RMV PN/GASTR STIMUL
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 64595
|
| Hospital Charge Code |
76102340
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
