|
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 |
$855.00 |
| Rate for Payer: Aetna Commercial |
$791.94
|
| Rate for Payer: Ambetter Exchange |
$467.29
|
| Rate for Payer: Anthem Medicaid |
$446.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$560.75
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$467.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.29
|
| 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 |
$607.48
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.29
|
|
|
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 |
$855.00 |
| Rate for Payer: Aetna Commercial |
$791.94
|
| Rate for Payer: Ambetter Exchange |
$467.29
|
| Rate for Payer: Anthem Medicaid |
$446.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$467.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$467.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$560.75
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$467.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.29
|
| 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 |
$607.48
|
| Rate for Payer: UHCCP Medicaid |
$498.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$450.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$467.29
|
|
|
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 |
$457.50 |
| Rate for Payer: Aetna Commercial |
$457.50
|
| Rate for Payer: Ambetter Exchange |
$314.31
|
| Rate for Payer: Anthem Medicaid |
$199.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$314.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$377.17
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$314.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$314.31
|
| 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 |
$408.60
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$314.31
|
|
|
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 |
$1,335.84 |
| Rate for Payer: Aetna Commercial |
$1,217.12
|
| Rate for Payer: Ambetter Exchange |
$782.47
|
| Rate for Payer: Anthem Medicaid |
$511.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$782.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$782.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$782.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$782.47
|
| 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 |
$1,017.21
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$516.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$782.47
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
76100469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$576.03 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,289.75
|
| Rate for Payer: Anthem Medicaid |
$576.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,306.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$581.89
|
| 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 |
$7,920.79
|
| 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 |
$1,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,457.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,155.75
|
| Rate for Payer: PHCS Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare All Payer |
$1,474.00
|
|
|
REVISION OF COLLAR BONE
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
HCPCS 23480
|
| Hospital Charge Code |
76100469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$502.50 |
| 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 |
$1,340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,457.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,155.75
|
| 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 |
$1,335.84 |
| Rate for Payer: Aetna Commercial |
$1,217.12
|
| Rate for Payer: Ambetter Exchange |
$782.47
|
| Rate for Payer: Anthem Medicaid |
$511.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$782.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$782.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$938.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$782.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$782.47
|
| 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 |
$1,017.21
|
| Rate for Payer: UHCCP Medicaid |
$586.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$516.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$782.47
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
761P1841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$449.75 |
| Max. Negotiated Rate |
$1,505.65 |
| Rate for Payer: Aetna Commercial |
$1,505.65
|
| Rate for Payer: Ambetter Exchange |
$997.34
|
| Rate for Payer: Anthem Medicaid |
$449.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$997.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$997.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,196.81
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,397.79
|
| Rate for Payer: Healthspan PPO |
$1,269.74
|
| Rate for Payer: Humana Medicaid |
$449.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$997.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$997.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.75
|
| Rate for Payer: Molina Healthcare Passport |
$449.75
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,296.54
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$997.34
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
76101841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$449.75 |
| Max. Negotiated Rate |
$1,505.65 |
| Rate for Payer: Aetna Commercial |
$1,505.65
|
| Rate for Payer: Ambetter Exchange |
$997.34
|
| Rate for Payer: Anthem Medicaid |
$449.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$997.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$997.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,196.81
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,397.79
|
| Rate for Payer: Healthspan PPO |
$1,269.74
|
| Rate for Payer: Humana Medicaid |
$449.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$997.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$997.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.75
|
| Rate for Payer: Molina Healthcare Passport |
$449.75
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,296.54
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$997.34
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
76101841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
76101841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
REVISION OF DIAPHRAGM
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
76101622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,401.81 |
| Rate for Payer: Aetna Commercial |
$1,361.77
|
| Rate for Payer: Ambetter Exchange |
$847.41
|
| Rate for Payer: Anthem Medicaid |
$598.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$847.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$847.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,016.89
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,401.81
|
| Rate for Payer: Healthspan PPO |
$1,088.86
|
| Rate for Payer: Humana Medicaid |
$598.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,186.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$847.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$847.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$610.76
|
| Rate for Payer: Molina Healthcare Passport |
$598.78
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,101.63
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$604.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$847.41
|
|
|
REVISION OF DIAPHRAGM
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
76101622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REVISION OF DIAPHRAGM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
76101622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$957.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REVISION OF DIAPHRAGM(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
761P1622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,401.81 |
| Rate for Payer: Aetna Commercial |
$1,361.77
|
| Rate for Payer: Ambetter Exchange |
$847.41
|
| Rate for Payer: Anthem Medicaid |
$598.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$847.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$847.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,016.89
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,401.81
|
| Rate for Payer: Healthspan PPO |
$1,088.86
|
| Rate for Payer: Humana Medicaid |
$598.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,186.09
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$847.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$847.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$610.76
|
| Rate for Payer: Molina Healthcare Passport |
$598.78
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,101.63
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$604.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$847.41
|
|
|
REVISION OF EYELID
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
76102400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REVISION OF EYELID
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
76102399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.05 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Aetna Commercial |
$617.18
|
| Rate for Payer: Ambetter Exchange |
$424.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.05
|
| Rate for Payer: Anthem Medicaid |
$370.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$424.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$424.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$509.72
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$610.65
|
| Rate for Payer: Healthspan PPO |
$668.05
|
| Rate for Payer: Humana Medicaid |
$370.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$424.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$424.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.49
|
| Rate for Payer: Molina Healthcare Passport |
$370.09
|
| Rate for Payer: Multiplan PHCS |
$982.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$552.20
|
| Rate for Payer: UHCCP Medicaid |
$258.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$424.77
|
|
|
REVISION OF EYELID
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
76102399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$563.31 |
| Max. Negotiated Rate |
$3,017.85 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem Medicaid |
$563.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,155.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,277.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,017.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,910.07
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Humana KY Medicaid |
$563.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,155.61
|
| Rate for Payer: Kentucky WC Medicaid |
$569.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$574.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.22
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
REVISION OF EYELID
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
76102400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REVISION OF EYELID
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
76102400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.53 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Ambetter Exchange |
$417.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.53
|
| Rate for Payer: Anthem Medicaid |
$362.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$417.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.41
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$594.13
|
| Rate for Payer: Healthspan PPO |
$665.68
|
| Rate for Payer: Humana Medicaid |
$362.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$417.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.19
|
| Rate for Payer: Molina Healthcare Passport |
$362.93
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.19
|
| Rate for Payer: UHCCP Medicaid |
$249.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$417.84
|
|
|
REVISION OF EYELID
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
76102399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$1,572.48 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,277.64
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,130.22
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
REVISION OF EYELID(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
761P2400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.53 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Ambetter Exchange |
$417.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.53
|
| Rate for Payer: Anthem Medicaid |
$362.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$417.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.41
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$594.13
|
| Rate for Payer: Healthspan PPO |
$665.68
|
| Rate for Payer: Humana Medicaid |
$362.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$417.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.19
|
| Rate for Payer: Molina Healthcare Passport |
$362.93
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.19
|
| Rate for Payer: UHCCP Medicaid |
$249.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$417.84
|
|
|
REVISION OF EYELID(P
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
761P2399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.05 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Aetna Commercial |
$617.18
|
| Rate for Payer: Ambetter Exchange |
$424.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.05
|
| Rate for Payer: Anthem Medicaid |
$370.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$424.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$424.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$509.72
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$610.65
|
| Rate for Payer: Healthspan PPO |
$668.05
|
| Rate for Payer: Humana Medicaid |
$370.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$424.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$424.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.49
|
| Rate for Payer: Molina Healthcare Passport |
$370.09
|
| Rate for Payer: Multiplan PHCS |
$982.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$552.20
|
| Rate for Payer: UHCCP Medicaid |
$258.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$424.77
|
|
|
REVISION OF FOOT
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
76100983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
REVISION OF FOOT
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
76100983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$946.44 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Ambetter Exchange |
$495.88
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.96
|
| Rate for Payer: Anthem Medicaid |
$341.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$495.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$595.06
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$929.84
|
| Rate for Payer: Healthspan PPO |
$946.44
|
| Rate for Payer: Humana Medicaid |
$341.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$706.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$495.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.72
|
| Rate for Payer: Molina Healthcare Passport |
$341.88
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.64
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.88
|
|
