|
SHOULDER KEELED GLENOID SZ #7
|
Facility
|
OP
|
$7,374.16
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,212.25 |
| Max. Negotiated Rate |
$7,079.19 |
| Rate for Payer: Aetna Commercial |
$5,678.10
|
| Rate for Payer: Anthem Medicaid |
$2,535.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.84
|
| Rate for Payer: Cash Price |
$3,687.08
|
| Rate for Payer: Cigna Commercial |
$6,120.55
|
| Rate for Payer: First Health Commercial |
$7,005.45
|
| Rate for Payer: Humana Commercial |
$6,268.04
|
| Rate for Payer: Humana KY Medicaid |
$2,535.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,561.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,442.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,586.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,489.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,899.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,415.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,088.17
|
| Rate for Payer: PHCS Commercial |
$7,079.19
|
| Rate for Payer: United Healthcare All Payer |
$6,489.26
|
|
|
SHOULDER KEELED GLENOID SZ #9
|
Facility
|
IP
|
$7,648.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.59 |
| Max. Negotiated Rate |
$7,342.69 |
| Rate for Payer: Aetna Commercial |
$5,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.94
|
| Rate for Payer: Cash Price |
$3,824.32
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: First Health Commercial |
$7,266.21
|
| Rate for Payer: Humana Commercial |
$6,501.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,644.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,730.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,736.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,654.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,277.56
|
| Rate for Payer: PHCS Commercial |
$7,342.69
|
| Rate for Payer: United Healthcare All Payer |
$6,730.80
|
|
|
SHOULDER KEELED GLENOID SZ #9
|
Facility
|
OP
|
$7,648.64
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,294.59 |
| Max. Negotiated Rate |
$7,342.69 |
| Rate for Payer: Aetna Commercial |
$5,889.45
|
| Rate for Payer: Anthem Medicaid |
$2,630.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.94
|
| Rate for Payer: Cash Price |
$3,824.32
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: First Health Commercial |
$7,266.21
|
| Rate for Payer: Humana Commercial |
$6,501.34
|
| Rate for Payer: Humana KY Medicaid |
$2,630.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,657.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,644.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,683.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,730.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,736.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,118.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,654.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,277.56
|
| Rate for Payer: PHCS Commercial |
$7,342.69
|
| Rate for Payer: United Healthcare All Payer |
$6,730.80
|
|
|
SHOULDER PROSTHESIS REMOVAL
|
Facility
|
IP
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.50 |
| 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 |
$2,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,710.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.35
|
| Rate for Payer: PHCS Commercial |
$2,990.40
|
| Rate for Payer: United Healthcare All Payer |
$2,741.20
|
|
|
SHOULDER PROSTHESIS REMOVAL
|
Facility
|
OP
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$934.50 |
| Max. Negotiated Rate |
$2,990.40 |
| Rate for Payer: Aetna Commercial |
$2,398.55
|
| Rate for Payer: Anthem Medicaid |
$1,071.25
|
| 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: Humana KY Medicaid |
$1,071.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,082.15
|
| 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: Molina Healthcare Medicaid |
$1,092.74
|
| 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 |
$2,492.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,710.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.35
|
| Rate for Payer: PHCS Commercial |
$2,990.40
|
| Rate for Payer: United Healthcare All Payer |
$2,741.20
|
|
|
SHOULDER PROSTHESIS REMOVAL
|
Professional
|
Both
|
$3,115.00
|
|
|
Service Code
|
HCPCS 23335
|
| Hospital Charge Code |
76100453
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,009.28 |
| Max. Negotiated Rate |
$2,380.09 |
| Rate for Payer: Ambetter Exchange |
$1,201.53
|
| Rate for Payer: Anthem Medicaid |
$1,009.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,201.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,201.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,441.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,201.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.53
|
| 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 |
$1,561.99
|
| Rate for Payer: UHCCP Medicaid |
$1,090.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,019.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,201.53
|
|
|
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 |
$2,380.09 |
| Rate for Payer: Ambetter Exchange |
$1,201.53
|
| Rate for Payer: Anthem Medicaid |
$1,009.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,201.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,201.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,441.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$1,201.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.53
|
| 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 |
$1,561.99
|
| Rate for Payer: UHCCP Medicaid |
$1,090.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,019.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,201.53
|
|
|
Shoulders Laser Hair Removal
|
Professional
|
Both
|
$350.00
|
|
| Hospital Charge Code |
22200214
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$245.00 |
| 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 |
$1,817.20 |
| 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 |
$778.80 |
| 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 |
$2,076.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,258.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,791.24
|
| 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 |
$221.64 |
| 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 |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,024.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| 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 |
$221.64
|
| 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 |
$265.97
|
| 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 |
$2,076.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,258.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,791.24
|
| 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 |
$1,817.20 |
| 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 |
$312.20 |
| 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 |
$156.10 |
| 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
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SHRIMP IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
SHUTTLE SELECT GUIDING SHEATH
|
Facility
|
OP
|
$1,921.26
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.38 |
| Max. Negotiated Rate |
$1,844.41 |
| Rate for Payer: Aetna Commercial |
$1,479.37
|
| Rate for Payer: Anthem Medicaid |
$660.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.58
|
| Rate for Payer: Cash Price |
$960.63
|
| Rate for Payer: Cigna Commercial |
$1,594.65
|
| Rate for Payer: First Health Commercial |
$1,825.20
|
| Rate for Payer: Humana Commercial |
$1,633.07
|
| Rate for Payer: Humana KY Medicaid |
$660.72
|
| Rate for Payer: Kentucky WC Medicaid |
$667.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,575.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,537.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,671.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.67
|
| Rate for Payer: PHCS Commercial |
$1,844.41
|
| Rate for Payer: United Healthcare All Payer |
$1,690.71
|
|
|
SHUTTLE SELECT GUIDING SHEATH
|
Facility
|
IP
|
$1,921.26
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.38 |
| Max. Negotiated Rate |
$1,844.41 |
| Rate for Payer: Aetna Commercial |
$1,479.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.58
|
| Rate for Payer: Cash Price |
$960.63
|
| Rate for Payer: Cigna Commercial |
$1,594.65
|
| Rate for Payer: First Health Commercial |
$1,825.20
|
| Rate for Payer: Humana Commercial |
$1,633.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,575.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,537.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,671.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.67
|
| Rate for Payer: PHCS Commercial |
$1,844.41
|
| Rate for Payer: United Healthcare All Payer |
$1,690.71
|
|
|
SIALOLITHOTOMY
|
Professional
|
Both
|
$4,793.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
76101681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$2,875.80 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Ambetter Exchange |
$155.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.17
|
| Rate for Payer: Anthem Medicaid |
$95.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$155.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.74
|
| Rate for Payer: Cash Price |
$2,396.50
|
| Rate for Payer: Cash Price |
$2,396.50
|
| Rate for Payer: Cigna Commercial |
$311.61
|
| Rate for Payer: Healthspan PPO |
$270.73
|
| Rate for Payer: Humana Medicaid |
$95.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$155.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.72
|
| Rate for Payer: Molina Healthcare Passport |
$95.80
|
| Rate for Payer: Multiplan PHCS |
$2,875.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$202.31
|
| Rate for Payer: UHCCP Medicaid |
$105.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$155.62
|
|
|
SIALOLITHOTOMY
|
Facility
|
OP
|
$4,793.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
76101681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,648.31 |
| Max. Negotiated Rate |
$4,601.28 |
| Rate for Payer: Aetna Commercial |
$3,690.61
|
| Rate for Payer: Anthem Medicaid |
$1,648.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,396.50
|
| Rate for Payer: Cash Price |
$2,396.50
|
| Rate for Payer: Cigna Commercial |
$3,978.19
|
| Rate for Payer: First Health Commercial |
$4,553.35
|
| Rate for Payer: Humana Commercial |
$4,074.05
|
| Rate for Payer: Humana KY Medicaid |
$1,648.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,217.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,594.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,834.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,169.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.17
|
| Rate for Payer: PHCS Commercial |
$4,601.28
|
| Rate for Payer: United Healthcare All Payer |
$4,217.84
|
|
|
SIALOLITHOTOMY
|
Facility
|
IP
|
$4,793.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
76101681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,437.90 |
| Max. Negotiated Rate |
$4,601.28 |
| Rate for Payer: Aetna Commercial |
$3,690.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.54
|
| Rate for Payer: Cash Price |
$2,396.50
|
| Rate for Payer: Cigna Commercial |
$3,978.19
|
| Rate for Payer: First Health Commercial |
$4,553.35
|
| Rate for Payer: Humana Commercial |
$4,074.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,217.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,594.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,834.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,169.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.17
|
| Rate for Payer: PHCS Commercial |
$4,601.28
|
| Rate for Payer: United Healthcare All Payer |
$4,217.84
|
|
|
SIALOLITHOTOMY(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
761P1681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$311.61 |
| Rate for Payer: Aetna Commercial |
$238.07
|
| Rate for Payer: Ambetter Exchange |
$155.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.17
|
| Rate for Payer: Anthem Medicaid |
$95.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$155.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$155.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.74
|
| 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 |
$95.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$212.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$155.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.72
|
| Rate for Payer: Molina Healthcare Passport |
$95.80
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$202.31
|
| Rate for Payer: UHCCP Medicaid |
$105.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$155.62
|
|
|
SIALOLITHOTOMY; PAROTID, EXTRAORAL OR COMPLICATED INTRAORAL
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 42340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, INTRAORAL
|
Facility
|
OP
|
$4,195.14
|
|
|
Service Code
|
CPT 42335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,996.53 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
|
|
SIALOLITHOTOMY(T
|
Facility
|
OP
|
$4,493.00
|
|
|
Service Code
|
HCPCS 42330
|
| Hospital Charge Code |
761T1681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,545.14 |
| Max. Negotiated Rate |
$4,313.28 |
| Rate for Payer: Aetna Commercial |
$3,459.61
|
| Rate for Payer: Anthem Medicaid |
$1,545.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,246.50
|
| Rate for Payer: Cash Price |
$2,246.50
|
| Rate for Payer: Cigna Commercial |
$3,729.19
|
| Rate for Payer: First Health Commercial |
$4,268.35
|
| Rate for Payer: Humana Commercial |
$3,819.05
|
| Rate for Payer: Humana KY Medicaid |
$1,545.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,560.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,594.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,100.17
|
| Rate for Payer: PHCS Commercial |
$4,313.28
|
| Rate for Payer: United Healthcare All Payer |
$3,953.84
|
|
