|
TRANSPLANT HAND TENDON
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
76100708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$321.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
TRANSPLANT HAND TENDON
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
76100708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.75
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
TRANSPLANT HAND TENDON(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26480
|
| Hospital Charge Code |
761P0708
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.75 |
| Max. Negotiated Rate |
$1,323.87 |
| Rate for Payer: Aetna Commercial |
$1,052.65
|
| Rate for Payer: Anthem Medicaid |
$392.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.00
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$1,323.87
|
| Rate for Payer: Healthspan PPO |
$953.48
|
| Rate for Payer: Humana Medicaid |
$392.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$906.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$400.41
|
| Rate for Payer: Molina Healthcare Passport |
$392.56
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$647.50
|
| Rate for Payer: UHCCP Medicaid |
$323.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$396.49
|
|
|
TRANSPLANT PALM TENDON
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 26485
|
| Hospital Charge Code |
36001267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,413.52 |
| Rate for Payer: Aetna Commercial |
$1,142.15
|
| Rate for Payer: Anthem Medicaid |
$414.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,005.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,413.52
|
| Rate for Payer: Healthspan PPO |
$1,034.55
|
| Rate for Payer: Humana Medicaid |
$414.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.49
|
| Rate for Payer: Molina Healthcare Passport |
$414.21
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.50
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.35
|
|
|
TRANSPLANT PALM TENDON
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 26485
|
| Hospital Charge Code |
360P1267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,413.52 |
| Rate for Payer: Aetna Commercial |
$1,142.15
|
| Rate for Payer: Anthem Medicaid |
$414.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,005.00
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,413.52
|
| Rate for Payer: Healthspan PPO |
$1,034.55
|
| Rate for Payer: Humana Medicaid |
$414.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$977.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.49
|
| Rate for Payer: Molina Healthcare Passport |
$414.21
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$703.50
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.35
|
|
|
TRANS,RADIAL BRACHIAL ARTERY
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
TRANS,RADIAL BRACHIAL ARTERY
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
TRANS,RADIAL BRACHIAL ARTERY
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 37799
|
| Hospital Charge Code |
76102810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
|
|
TRANSTHOR CATH FOR STENT
|
Professional
|
Both
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
76101315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.82 |
| Max. Negotiated Rate |
$1,712.89 |
| Rate for Payer: Aetna Commercial |
$1,639.44
|
| Rate for Payer: Anthem Medicaid |
$810.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,076.62
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$1,712.89
|
| Rate for Payer: Healthspan PPO |
$1,208.68
|
| Rate for Payer: Humana Medicaid |
$810.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,250.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$827.10
|
| Rate for Payer: Molina Healthcare Passport |
$810.88
|
| Rate for Payer: Multiplan PHCS |
$645.97
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$753.63
|
| Rate for Payer: UHCCP Medicaid |
$376.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.99
|
|
|
TRANSTHOR CATH FOR STENT
|
Facility
|
IP
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
76101315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$1,033.56 |
| Rate for Payer: Aetna Commercial |
$829.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$893.59
|
| Rate for Payer: First Health Commercial |
$1,022.79
|
| Rate for Payer: Humana Commercial |
$915.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$882.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.43
|
| Rate for Payer: Ohio Health Group HMO |
$807.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.75
|
| Rate for Payer: PHCS Commercial |
$1,033.56
|
| Rate for Payer: United Healthcare All Payer |
$947.43
|
|
|
TRANSTHOR CATH FOR STENT
|
Facility
|
OP
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
76101315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.96 |
| Max. Negotiated Rate |
$1,033.56 |
| Rate for Payer: Aetna Commercial |
$829.00
|
| Rate for Payer: Anthem Medicaid |
$370.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$893.59
|
| Rate for Payer: First Health Commercial |
$1,022.79
|
| Rate for Payer: Humana Commercial |
$915.13
|
| Rate for Payer: Humana KY Medicaid |
$370.25
|
| Rate for Payer: Kentucky WC Medicaid |
$374.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$882.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.43
|
| Rate for Payer: Ohio Health Group HMO |
$807.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.75
|
| Rate for Payer: PHCS Commercial |
$1,033.56
|
| Rate for Payer: United Healthcare All Payer |
$947.43
|
|
|
TRANSTHOR CATH FOR STENT(P
|
Professional
|
Both
|
$1,076.62
|
|
|
Service Code
|
HCPCS 33621
|
| Hospital Charge Code |
761P1315
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$376.82 |
| Max. Negotiated Rate |
$1,712.89 |
| Rate for Payer: Aetna Commercial |
$1,639.44
|
| Rate for Payer: Anthem Medicaid |
$810.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,076.62
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cash Price |
$538.31
|
| Rate for Payer: Cigna Commercial |
$1,712.89
|
| Rate for Payer: Healthspan PPO |
$1,208.68
|
| Rate for Payer: Humana Medicaid |
$810.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,250.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$827.10
|
| Rate for Payer: Molina Healthcare Passport |
$810.88
|
| Rate for Payer: Multiplan PHCS |
$645.97
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$753.63
|
| Rate for Payer: UHCCP Medicaid |
$376.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$818.99
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
76101775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.75
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
76101775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$2,113.55
|
| Rate for Payer: Anthem Medicaid |
$1,133.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,125.00
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,200.98
|
| Rate for Payer: Healthspan PPO |
$1,337.04
|
| Rate for Payer: Humana Medicaid |
$1,133.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,685.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,156.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,133.99
|
| Rate for Payer: Multiplan PHCS |
$1,875.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,187.50
|
| Rate for Payer: UHCCP Medicaid |
$1,093.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,145.33
|
|
|
TRANSTHOR DIAPHRAG HERN RPR
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
76101775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$968.75
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
TRANSTHOR DIAPHRAG HERN RPR(P
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 43334
|
| Hospital Charge Code |
761P1775
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,093.75 |
| Max. Negotiated Rate |
$3,125.00 |
| Rate for Payer: Aetna Commercial |
$2,113.55
|
| Rate for Payer: Anthem Medicaid |
$1,133.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,125.00
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,200.98
|
| Rate for Payer: Healthspan PPO |
$1,337.04
|
| Rate for Payer: Humana Medicaid |
$1,133.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,685.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,156.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,133.99
|
| Rate for Payer: Multiplan PHCS |
$1,875.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,187.50
|
| Rate for Payer: UHCCP Medicaid |
$1,093.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,145.33
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$6,264.36
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,474.54 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$17,952.06
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$12,181.76 |
| Max. Negotiated Rate |
$17,952.06 |
| Rate for Payer: Anthem Medicaid |
$12,181.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,822.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,952.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,310.92
|
| Rate for Payer: Humana KY Medicaid |
$12,181.76
|
| Rate for Payer: Humana Medicare Advantage |
$12,822.90
|
| Rate for Payer: Kentucky WC Medicaid |
$12,303.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,387.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,425.39
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$32,965.53
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$22,369.47 |
| Max. Negotiated Rate |
$32,965.53 |
| Rate for Payer: Anthem Medicaid |
$22,369.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23,546.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32,965.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$31,788.19
|
| Rate for Payer: Humana KY Medicaid |
$22,369.47
|
| Rate for Payer: Humana Medicare Advantage |
$23,546.81
|
| Rate for Payer: Kentucky WC Medicaid |
$22,593.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28,256.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,816.86
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,260.70
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$7,641.19 |
| Max. Negotiated Rate |
$11,260.70 |
| Rate for Payer: Anthem Medicaid |
$7,641.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,043.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,260.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,858.54
|
| Rate for Payer: Humana KY Medicaid |
$7,641.19
|
| Rate for Payer: Humana Medicare Advantage |
$8,043.36
|
| Rate for Payer: Kentucky WC Medicaid |
$7,717.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,652.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,794.02
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$16,970.59
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$11,515.76 |
| Max. Negotiated Rate |
$16,970.59 |
| Rate for Payer: Anthem Medicaid |
$11,515.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,121.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,970.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,364.50
|
| Rate for Payer: Humana KY Medicaid |
$11,515.76
|
| Rate for Payer: Humana Medicare Advantage |
$12,121.85
|
| Rate for Payer: Kentucky WC Medicaid |
$11,630.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,546.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,746.07
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$11,212.71
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$7,608.63 |
| Max. Negotiated Rate |
$11,212.71 |
| Rate for Payer: Anthem Medicaid |
$7,608.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,009.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,212.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,812.26
|
| Rate for Payer: Humana KY Medicaid |
$7,608.63
|
| Rate for Payer: Humana Medicare Advantage |
$8,009.08
|
| Rate for Payer: Kentucky WC Medicaid |
$7,684.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,610.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,760.80
|
|
|
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE
|
Facility
|
OP
|
$4,220.54
|
|
|
Service Code
|
CPT 52640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,014.67 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
|
|
TRANSURETHRAL RESECTION; RESIDUAL OR REGROWTH OF OBSTRUCTIVE PROSTATE TISSUE INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$6,264.36
|
|
|
Service Code
|
CPT 52630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,474.54 |
| Max. Negotiated Rate |
$6,264.36 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,474.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,264.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,040.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,474.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,369.45
|
|
