|
WAYNE PNEUMOTHORAX SELDINGER
|
Facility
|
OP
|
$3,065.75
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$919.73 |
| Max. Negotiated Rate |
$2,943.12 |
| Rate for Payer: Aetna Commercial |
$2,360.63
|
| Rate for Payer: Anthem Medicaid |
$1,054.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,391.28
|
| Rate for Payer: Cash Price |
$1,532.88
|
| Rate for Payer: Cigna Commercial |
$2,544.57
|
| Rate for Payer: First Health Commercial |
$2,912.46
|
| Rate for Payer: Humana Commercial |
$2,605.89
|
| Rate for Payer: Humana KY Medicaid |
$1,054.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,065.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,513.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,262.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$919.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,075.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,697.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,299.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,667.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,115.37
|
| Rate for Payer: PHCS Commercial |
$2,943.12
|
| Rate for Payer: United Healthcare All Payer |
$2,697.86
|
|
|
WAYNE PNEUMOTHORAX SELDINGER
|
Facility
|
IP
|
$3,065.75
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$919.73 |
| Max. Negotiated Rate |
$2,943.12 |
| Rate for Payer: Aetna Commercial |
$2,360.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,391.28
|
| Rate for Payer: Cash Price |
$1,532.88
|
| Rate for Payer: Cigna Commercial |
$2,544.57
|
| Rate for Payer: First Health Commercial |
$2,912.46
|
| Rate for Payer: Humana Commercial |
$2,605.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,513.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,262.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$919.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,697.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,299.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,667.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,115.37
|
| Rate for Payer: PHCS Commercial |
$2,943.12
|
| Rate for Payer: United Healthcare All Payer |
$2,697.86
|
|
|
WBC STOOL W/T INTERP
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
30001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| 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 |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
WBC STOOL W/T INTERP
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
30001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Ambetter Exchange |
$4.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$4.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$4.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.12
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Healthspan PPO |
$4.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.27
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.55
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$4.27
|
|
|
WBC STOOL W/T INTERP
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 89055
|
| Hospital Charge Code |
30001547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.15
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
WCD DEVICE INTERROGATE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 93292
|
| Hospital Charge Code |
48000116
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$42.99
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$43.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
WCD DEVICE INTERROGATE
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 93292
|
| Hospital Charge Code |
48000116
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$61.28
|
| Rate for Payer: Ambetter Exchange |
$45.85
|
| Rate for Payer: Anthem Medicaid |
$30.86
|
| Rate for Payer: Buckeye Individual/Medicaid |
$45.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.02
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$61.65
|
| Rate for Payer: Healthspan PPO |
$57.59
|
| Rate for Payer: Humana Medicaid |
$30.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$45.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.48
|
| Rate for Payer: Molina Healthcare Passport |
$30.86
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.60
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$31.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$45.85
|
|
|
WCD DEVICE INTERROGATE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 93292
|
| Hospital Charge Code |
48000116
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
WEANING PROCEDURE
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
41000094
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$81.50 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem Medicaid |
$81.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Humana KY Medicaid |
$81.50
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$82.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.53
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
WEANING PROCEDURE
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
HCPCS 94799
|
| Hospital Charge Code |
41000094
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$71.10 |
| Max. Negotiated Rate |
$227.52 |
| Rate for Payer: Aetna Commercial |
$182.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.86
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$196.71
|
| Rate for Payer: First Health Commercial |
$225.15
|
| Rate for Payer: Humana Commercial |
$201.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$194.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$174.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$208.56
|
| Rate for Payer: Ohio Health Group HMO |
$177.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.53
|
| Rate for Payer: PHCS Commercial |
$227.52
|
| Rate for Payer: United Healthcare All Payer |
$208.56
|
|
|
WEDGE RESECTION - BIL.
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
76102261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| 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 |
$1,065.89 |
| Rate for Payer: Aetna Commercial |
$1,065.89
|
| Rate for Payer: Ambetter Exchange |
$675.85
|
| Rate for Payer: Anthem Medicaid |
$400.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$811.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$675.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.85
|
| 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 |
$878.61
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.85
|
|
|
WEDGE RESECTION - BIL.
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 58920
|
| Hospital Charge Code |
76102261
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$9,565.72 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,832.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,565.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,224.09
|
| 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 |
$6,832.66
|
| 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 |
$8,199.19
|
| 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 |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
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 |
$1,065.89 |
| Rate for Payer: Aetna Commercial |
$1,065.89
|
| Rate for Payer: Ambetter Exchange |
$675.85
|
| Rate for Payer: Anthem Medicaid |
$400.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$811.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$675.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.85
|
| 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 |
$878.61
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$404.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.85
|
|
|
WEDGE RESECT OF LUNG DIAG
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 32507
|
| Hospital Charge Code |
76101196
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| 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 |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| 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 |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| 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 |
$189.15
|
| 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 |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| 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 |
$330.00 |
| Rate for Payer: Ambetter Exchange |
$146.11
|
| Rate for Payer: Anthem Medicaid |
$128.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$146.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.11
|
| 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 |
$189.94
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.11
|
|
|
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 |
$330.00 |
| Rate for Payer: Ambetter Exchange |
$146.11
|
| Rate for Payer: Anthem Medicaid |
$128.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$146.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$146.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$175.33
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$146.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.11
|
| 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 |
$189.94
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$146.11
|
|
|
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 |
$1,755.80 |
| Rate for Payer: Ambetter Exchange |
$877.99
|
| Rate for Payer: Anthem Medicaid |
$757.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$877.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,053.59
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$877.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.99
|
| 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 |
$1,141.39
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$764.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$877.99
|
|
|
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 |
$675.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.77
|
| 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 |
$773.77
|
| 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 |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| 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 |
$675.00 |
| 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 |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| 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 |
$1,755.80 |
| Rate for Payer: Ambetter Exchange |
$877.99
|
| Rate for Payer: Anthem Medicaid |
$757.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$877.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,053.59
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$877.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$877.99
|
| 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 |
$1,141.39
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$764.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$877.99
|
|
|
WEDG EXC SKIN NAIL FOLDINGR NL
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
761T0103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
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 |
$33.67 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$95.92
|
| Rate for Payer: Ambetter Exchange |
$87.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$46.55
|
| Rate for Payer: Anthem Medicaid |
$33.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.41
|
| 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 |
$33.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$82.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$34.34
|
| Rate for Payer: Molina Healthcare Passport |
$33.67
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.11
|
| Rate for Payer: UHCCP Medicaid |
$48.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.01
|
|
|
WEDG EXC SKIN NAIL FOLDINGR NL
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
HCPCS 11765
|
| Hospital Charge Code |
76100103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.41 |
| Max. Negotiated Rate |
$824.64 |
| Rate for Payer: Aetna Commercial |
$661.43
|
| Rate for Payer: Anthem Medicaid |
$295.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cash Price |
$429.50
|
| Rate for Payer: Cigna Commercial |
$712.97
|
| Rate for Payer: First Health Commercial |
$816.05
|
| Rate for Payer: Humana Commercial |
$730.15
|
| Rate for Payer: Humana KY Medicaid |
$295.41
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$298.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$704.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$633.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$755.92
|
| Rate for Payer: Ohio Health Group HMO |
$644.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$687.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$747.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.71
|
| Rate for Payer: PHCS Commercial |
$824.64
|
| Rate for Payer: United Healthcare All Payer |
$755.92
|
|
