|
WATER FOR INJECTION 10 ML 10ML
|
Facility
|
IP
|
$11.52
|
|
| Hospital Charge Code |
636T0101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna Commercial |
$8.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8.99
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cigna Commercial |
$9.56
|
| Rate for Payer: First Health Commercial |
$10.94
|
| Rate for Payer: Humana Commercial |
$9.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10.14
|
| Rate for Payer: Ohio Health Group HMO |
$8.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.57
|
| Rate for Payer: PHCS Commercial |
$11.06
|
| Rate for Payer: United Healthcare All Payer |
$10.14
|
|
|
WATER FOR INJECTION 10 ML 10ML
|
Facility
|
OP
|
$80.39
|
|
|
Service Code
|
NDC 409488717
|
| Hospital Charge Code |
25003594
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$77.17 |
| Rate for Payer: Aetna Commercial |
$61.90
|
| Rate for Payer: Anthem Medicaid |
$27.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.70
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$66.72
|
| Rate for Payer: First Health Commercial |
$76.37
|
| Rate for Payer: Humana Commercial |
$68.33
|
| Rate for Payer: Humana KY Medicaid |
$27.65
|
| Rate for Payer: Kentucky WC Medicaid |
$27.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.74
|
| Rate for Payer: Ohio Health Group HMO |
$60.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.92
|
| Rate for Payer: PHCS Commercial |
$77.17
|
| Rate for Payer: United Healthcare All Payer |
$70.74
|
|
|
WATERJET PROSTATE ABLTJ CMPL
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 0421T
|
| Hospital Charge Code |
76102798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$11,152.93 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7,966.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11,152.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$10,754.61
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$7,966.38
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,559.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
WATERJET PROSTATE ABLTJ CMPL
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 0421T
|
| Hospital Charge Code |
76102798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
WATERJET PROSTATE ABLTJ CMPL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 0421T
|
| Hospital Charge Code |
76102798
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
|
|
WAYNE PNEUMOTHORAX SELDINGER
|
Facility
|
IP
|
$3,154.10
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.03 |
| Max. Negotiated Rate |
$3,027.94 |
| Rate for Payer: Aetna Commercial |
$2,428.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,460.20
|
| Rate for Payer: Cash Price |
$1,577.05
|
| Rate for Payer: Cigna Commercial |
$2,617.90
|
| Rate for Payer: First Health Commercial |
$2,996.40
|
| Rate for Payer: Humana Commercial |
$2,680.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,586.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,327.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$946.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,775.61
|
| Rate for Payer: Ohio Health Group HMO |
$2,365.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.77
|
| Rate for Payer: PHCS Commercial |
$3,027.94
|
| Rate for Payer: United Healthcare All Payer |
$2,775.61
|
|
|
WAYNE PNEUMOTHORAX SELDINGER
|
Facility
|
OP
|
$3,154.10
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.03 |
| Max. Negotiated Rate |
$3,027.94 |
| Rate for Payer: Aetna Commercial |
$2,428.66
|
| Rate for Payer: Anthem Medicaid |
$1,084.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,460.20
|
| Rate for Payer: Cash Price |
$1,577.05
|
| Rate for Payer: Cigna Commercial |
$2,617.90
|
| Rate for Payer: First Health Commercial |
$2,996.40
|
| Rate for Payer: Humana Commercial |
$2,680.98
|
| Rate for Payer: Humana KY Medicaid |
$1,084.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,095.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,586.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,327.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$946.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,106.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,775.61
|
| Rate for Payer: Ohio Health Group HMO |
$2,365.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.77
|
| Rate for Payer: PHCS Commercial |
$3,027.94
|
| Rate for Payer: United Healthcare All Payer |
$2,775.61
|
|
|
WBC STOOL W/T INTERP
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
30001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Humana KY Medicaid |
$4.27
|
| Rate for Payer: Humana Medicare Advantage |
$4.27
|
| Rate for Payer: Kentucky WC Medicaid |
$4.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
WBC STOOL W/T INTERP
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
30001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Healthspan PPO |
$4.47
|
| Rate for Payer: Multiplan PHCS |
$28.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.90
|
| Rate for Payer: UHCCP Medicaid |
$16.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.56
|
|
|
WBC STOOL W/T INTERP
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
30001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.74
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
WEANING PROCEDURE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
41000094
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$214.08 |
| Rate for Payer: Aetna Commercial |
$171.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.94
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$185.09
|
| Rate for Payer: First Health Commercial |
$211.85
|
| Rate for Payer: Humana Commercial |
$189.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$164.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$196.24
|
| Rate for Payer: Ohio Health Group HMO |
$167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.13
|
| Rate for Payer: PHCS Commercial |
$214.08
|
| Rate for Payer: United Healthcare All Payer |
$196.24
|
|
|
WEANING PROCEDURE
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
41000094
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$214.08 |
| Rate for Payer: Aetna Commercial |
$171.71
|
| Rate for Payer: Anthem Medicaid |
$76.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cash Price |
$111.50
|
| Rate for Payer: Cigna Commercial |
$185.09
|
| Rate for Payer: First Health Commercial |
$211.85
|
| Rate for Payer: Humana Commercial |
$189.55
|
| Rate for Payer: Humana KY Medicaid |
$76.69
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$77.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$164.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$196.24
|
| Rate for Payer: Ohio Health Group HMO |
$167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.13
|
| Rate for Payer: PHCS Commercial |
$214.08
|
| Rate for Payer: United Healthcare All Payer |
$196.24
|
|
|
WEDGE RESECTION - BIL.
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
76102261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$9,148.36 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,534.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,148.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,821.63
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$6,534.54
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,841.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
WEDGE RESECTION - BIL.
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
76102261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
WEDGE RESECTION - BIL.
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
76102261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.39 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,065.89
|
| Rate for Payer: Anthem Medicaid |
$400.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,040.77
|
| Rate for Payer: Healthspan PPO |
$1,032.05
|
| Rate for Payer: Humana Medicaid |
$400.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$908.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$408.40
|
| Rate for Payer: Molina Healthcare Passport |
$400.39
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.39
|
|
|
WEDGE RESECTION - BIL.(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
761P2261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$400.39 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Aetna Commercial |
$1,065.89
|
| Rate for Payer: Anthem Medicaid |
$400.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,500.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,040.77
|
| Rate for Payer: Healthspan PPO |
$1,032.05
|
| Rate for Payer: Humana Medicaid |
$400.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$908.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$408.40
|
| Rate for Payer: Molina Healthcare Passport |
$400.39
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,050.00
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.39
|
|
|
WEDGE RESECT OF LUNG DIAG
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 32507
|
| Hospital Charge Code |
76101196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
WEDGE RESECT OF LUNG DIAG
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 32507
|
| Hospital Charge Code |
76101196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
WEDGE RESECT OF LUNG DIAG
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 32507
|
| Hospital Charge Code |
76101196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.37 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Anthem Medicaid |
$128.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$297.92
|
| Rate for Payer: Healthspan PPO |
$160.23
|
| Rate for Payer: Humana Medicaid |
$128.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.94
|
| Rate for Payer: Molina Healthcare Passport |
$128.37
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.65
|
|
|
WEDGE RESECT OF LUNG DIAG(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 32507
|
| Hospital Charge Code |
761P1196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.37 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Anthem Medicaid |
$128.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$297.92
|
| Rate for Payer: Healthspan PPO |
$160.23
|
| Rate for Payer: Humana Medicaid |
$128.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.94
|
| Rate for Payer: Molina Healthcare Passport |
$128.37
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.65
|
|
|
WEDGE RESECT OF LUNG INITIAL
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 32505
|
| Hospital Charge Code |
76101195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.06 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Anthem Medicaid |
$757.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,755.80
|
| Rate for Payer: Healthspan PPO |
$938.75
|
| Rate for Payer: Humana Medicaid |
$757.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,266.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$772.20
|
| Rate for Payer: Molina Healthcare Passport |
$757.06
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$764.63
|
|
|
WEDGE RESECT OF LUNG INITIAL
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 32505
|
| Hospital Charge Code |
76101195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Humana KY Medicaid |
$773.78
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
WEDGE RESECT OF LUNG INITIAL
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 32505
|
| Hospital Charge Code |
76101195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
WEDGE RESECT OF LUNG INITIA(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 32505
|
| Hospital Charge Code |
761P1195
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$757.06 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Anthem Medicaid |
$757.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,755.80
|
| Rate for Payer: Healthspan PPO |
$938.75
|
| Rate for Payer: Humana Medicaid |
$757.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,266.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$772.20
|
| Rate for Payer: Molina Healthcare Passport |
$757.06
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$764.63
|
|
|
WEDG EXC SKIN NAIL FOLDINGR NL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
761P0103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna Commercial |
$95.92
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.55
|
| Rate for Payer: Anthem Medicaid |
$26.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$153.14
|
| Rate for Payer: Healthspan PPO |
$139.17
|
| Rate for Payer: Humana Medicaid |
$26.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.37
|
| Rate for Payer: Molina Healthcare Passport |
$26.83
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$48.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$27.10
|
|
