|
SHOULDER PROSTHESIS REMOVAL
|
Facility
|
IP
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.95 |
| Max. Negotiated Rate |
$2,990.40 |
| Rate for Payer: Aetna Commercial |
$2,398.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,429.70
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cigna Commercial |
$2,585.45
|
| Rate for Payer: First Health Commercial |
$2,959.25
|
| Rate for Payer: Humana Commercial |
$2,647.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,554.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,298.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$934.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,741.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,336.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$623.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$965.65
|
| Rate for Payer: PHCS Commercial |
$2,990.40
|
| Rate for Payer: United Healthcare All Payer |
$2,741.20
|
|
|
SHOULDER PROSTHESIS REMOVAL(P
|
Professional
|
Both
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
761P0453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,009.28 |
| Max. Negotiated Rate |
$3,115.00 |
| Rate for Payer: Anthem Medicaid |
$1,009.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,115.00
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cash Price |
$1,557.50
|
| Rate for Payer: Cigna Commercial |
$2,380.09
|
| Rate for Payer: Healthspan PPO |
$1,867.46
|
| Rate for Payer: Humana Medicaid |
$1,009.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,643.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,029.47
|
| Rate for Payer: Molina Healthcare Passport |
$1,009.28
|
| Rate for Payer: Multiplan PHCS |
$1,869.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,180.50
|
| Rate for Payer: UHCCP Medicaid |
$1,090.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,019.37
|
|
|
Shoulders Laser Hair Removal
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
22200214
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
|
|
SHOULDER SURGERY PROCEDURE
|
Professional
|
Both
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23929
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,596.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,596.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,817.20
|
| Rate for Payer: UHCCP Medicaid |
$908.60
|
|
|
SHOULDER SURGERY PROCEDURE
|
Facility
|
IP
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23929
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$2,492.16 |
| Rate for Payer: Aetna Commercial |
$1,998.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$2,154.68
|
| Rate for Payer: First Health Commercial |
$2,466.20
|
| Rate for Payer: Humana Commercial |
$2,206.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$778.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,284.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.76
|
| Rate for Payer: PHCS Commercial |
$2,492.16
|
| Rate for Payer: United Healthcare All Payer |
$2,284.48
|
|
|
SHOULDER SURGERY PROCEDURE
|
Facility
|
OP
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23929
|
| Hospital Charge Code |
76100493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$2,492.16 |
| Rate for Payer: Aetna Commercial |
$1,998.92
|
| Rate for Payer: Anthem Medicaid |
$892.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cigna Commercial |
$2,154.68
|
| Rate for Payer: First Health Commercial |
$2,466.20
|
| Rate for Payer: Humana Commercial |
$2,206.60
|
| Rate for Payer: Humana KY Medicaid |
$892.76
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$901.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,128.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,915.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$910.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,284.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$804.76
|
| Rate for Payer: PHCS Commercial |
$2,492.16
|
| Rate for Payer: United Healthcare All Payer |
$2,284.48
|
|
|
SHOULDER SURGERY PROCEDURE(P
|
Professional
|
Both
|
$2,596.00
|
|
|
Service Code
|
HCPCS 23929
|
| Hospital Charge Code |
761P0493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,596.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,596.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Cash Price |
$1,298.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,557.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,817.20
|
| Rate for Payer: UHCCP Medicaid |
$908.60
|
|
|
Shouldrs LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$446.00
|
|
| Hospital Charge Code |
22200215
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$156.10 |
| Max. Negotiated Rate |
$446.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$446.00
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Multiplan PHCS |
$267.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$312.20
|
| Rate for Payer: UHCCP Medicaid |
$156.10
|
|
|
Shouldrs LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$223.00
|
|
| Hospital Charge Code |
22200473
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$78.05 |
| Max. Negotiated Rate |
$223.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$223.00
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Multiplan PHCS |
$133.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$156.10
|
| Rate for Payer: UHCCP Medicaid |
$78.05
|
|
|
SHRIMP IGE
|
Facility
|
IP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
SHRIMP IGE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Anthem Medicaid |
$22.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$53.95
|
| Rate for Payer: First Health Commercial |
$61.75
|
| Rate for Payer: Humana Commercial |
$55.25
|
| Rate for Payer: Humana KY Medicaid |
$22.35
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$22.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$53.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$57.20
|
| Rate for Payer: Ohio Health Group HMO |
$48.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.15
|
| Rate for Payer: PHCS Commercial |
$62.40
|
| Rate for Payer: United Healthcare All Payer |
$57.20
|
|
|
SHUTTLE SELECT GUIDING SHEATH
|
Facility
|
OP
|
$1,911.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$1,835.05 |
| Rate for Payer: Aetna Commercial |
$1,471.86
|
| Rate for Payer: Anthem Medicaid |
$657.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.98
|
| Rate for Payer: Cash Price |
$955.75
|
| Rate for Payer: Cigna Commercial |
$1,586.55
|
| Rate for Payer: First Health Commercial |
$1,815.93
|
| Rate for Payer: Humana Commercial |
$1,624.78
|
| Rate for Payer: Humana KY Medicaid |
$657.37
|
| Rate for Payer: Kentucky WC Medicaid |
$664.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.57
|
| Rate for Payer: PHCS Commercial |
$1,835.05
|
| Rate for Payer: United Healthcare All Payer |
$1,682.13
|
|
|
SHUTTLE SELECT GUIDING SHEATH
|
Facility
|
IP
|
$1,911.51
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$1,835.05 |
| Rate for Payer: Aetna Commercial |
$1,471.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,490.98
|
| Rate for Payer: Cash Price |
$955.75
|
| Rate for Payer: Cigna Commercial |
$1,586.55
|
| Rate for Payer: First Health Commercial |
$1,815.93
|
| Rate for Payer: Humana Commercial |
$1,624.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.57
|
| Rate for Payer: PHCS Commercial |
$1,835.05
|
| Rate for Payer: United Healthcare All Payer |
$1,682.13
|
|
|
SIALOLITHOTOMY
|
Facility
|
IP
|
$4,666.67
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
76101681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.67 |
| Max. Negotiated Rate |
$4,480.00 |
| Rate for Payer: Aetna Commercial |
$3,593.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.00
|
| Rate for Payer: Cash Price |
$2,333.34
|
| Rate for Payer: Cigna Commercial |
$3,873.34
|
| Rate for Payer: First Health Commercial |
$4,433.34
|
| Rate for Payer: Humana Commercial |
$3,966.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.67
|
| Rate for Payer: PHCS Commercial |
$4,480.00
|
| Rate for Payer: United Healthcare All Payer |
$4,106.67
|
|
|
SIALOLITHOTOMY
|
Professional
|
Both
|
$4,666.67
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
76101681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$4,666.67 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.17
|
| Rate for Payer: Anthem Medicaid |
$81.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,666.67
|
| Rate for Payer: Cash Price |
$2,333.34
|
| Rate for Payer: Cash Price |
$2,333.34
|
| Rate for Payer: Cigna Commercial |
$311.61
|
| Rate for Payer: Healthspan PPO |
$270.73
|
| Rate for Payer: Humana Medicaid |
$81.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.67
|
| Rate for Payer: Molina Healthcare Passport |
$81.05
|
| Rate for Payer: Multiplan PHCS |
$2,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,266.67
|
| Rate for Payer: UHCCP Medicaid |
$105.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.86
|
|
|
SIALOLITHOTOMY
|
Facility
|
OP
|
$4,666.67
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
76101681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$606.67 |
| Max. Negotiated Rate |
$4,480.00 |
| Rate for Payer: Aetna Commercial |
$3,593.34
|
| Rate for Payer: Anthem Medicaid |
$1,604.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.00
|
| 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 |
$2,333.34
|
| Rate for Payer: Cash Price |
$2,333.34
|
| Rate for Payer: Cigna Commercial |
$3,873.34
|
| Rate for Payer: First Health Commercial |
$4,433.34
|
| Rate for Payer: Humana Commercial |
$3,966.67
|
| Rate for Payer: Humana KY Medicaid |
$1,604.87
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.67
|
| Rate for Payer: PHCS Commercial |
$4,480.00
|
| Rate for Payer: United Healthcare All Payer |
$4,106.67
|
|
|
SIALOLITHOTOMY(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
761P1681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.05 |
| Max. Negotiated Rate |
$311.61 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.17
|
| Rate for Payer: Anthem Medicaid |
$81.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$311.61
|
| Rate for Payer: Healthspan PPO |
$270.73
|
| Rate for Payer: Humana Medicaid |
$81.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.67
|
| Rate for Payer: Molina Healthcare Passport |
$81.05
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.86
|
|
|
SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 42340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
|
Facility
|
OP
|
$3,897.84
|
|
|
Service Code
|
CPT 42335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,784.17 |
| Max. Negotiated Rate |
$3,897.84 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,897.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,758.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
|
|
SIALOLITHOTOMY(T
|
Facility
|
OP
|
$4,366.67
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
761T1681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.67 |
| Max. Negotiated Rate |
$4,192.00 |
| Rate for Payer: Aetna Commercial |
$3,362.34
|
| Rate for Payer: Anthem Medicaid |
$1,501.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,784.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,406.00
|
| 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 |
$2,183.34
|
| Rate for Payer: Cash Price |
$2,183.34
|
| Rate for Payer: Cigna Commercial |
$3,624.34
|
| Rate for Payer: First Health Commercial |
$4,148.34
|
| Rate for Payer: Humana Commercial |
$3,711.67
|
| Rate for Payer: Humana KY Medicaid |
$1,501.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,784.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,516.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,580.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,341.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,531.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,842.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$873.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.67
|
| Rate for Payer: PHCS Commercial |
$4,192.00
|
| Rate for Payer: United Healthcare All Payer |
$3,842.67
|
|
|
SIALOLITHOTOMY(T
|
Facility
|
IP
|
$4,366.67
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
761T1681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.67 |
| Max. Negotiated Rate |
$4,192.00 |
| Rate for Payer: Aetna Commercial |
$3,362.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Cash Price |
$2,183.34
|
| Rate for Payer: Cigna Commercial |
$3,624.34
|
| Rate for Payer: First Health Commercial |
$4,148.34
|
| Rate for Payer: Humana Commercial |
$3,711.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,580.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,222.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,842.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$873.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.67
|
| Rate for Payer: PHCS Commercial |
$4,192.00
|
| Rate for Payer: United Healthcare All Payer |
$3,842.67
|
|
|
SICKLE CELL SCREEN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
30000627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.51
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Humana Medicare Advantage |
$5.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
SICKLE CELL SCREEN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 85660
|
| Hospital Charge Code |
30000627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.44
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.49
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
Sideburn LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$129.00
|
|
| Hospital Charge Code |
22200209
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
Sideburn LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$63.00
|
|
| Hospital Charge Code |
22200470
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
|
