|
BLEPHAROPLASTY (LOWER EYELIDS)
|
Facility
|
OP
|
$1,170.00
|
|
| Hospital Charge Code |
22200040
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
BLEPHAROPLASTY (LOWER EYELIDS)
|
Facility
|
IP
|
$1,170.00
|
|
| Hospital Charge Code |
22200040
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
BLEPHAROPLASTY (LOWER EYELIDS)
|
Professional
|
Both
|
$1,170.00
|
|
| Hospital Charge Code |
22200040
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$819.00
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
|
|
BLEPHAROPLASTY, LOWER EYELID(T
|
Facility
|
OP
|
$3,915.00
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
761T0214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,346.37 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem Medicaid |
$1,346.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Humana KY Medicaid |
$1,346.37
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,406.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.35
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
|
BLEPHAROPLASTY, LOWER EYELID(T
|
Facility
|
IP
|
$3,915.00
|
|
|
Service Code
|
HCPCS 15820
|
| Hospital Charge Code |
761T0214
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,174.50 |
| Max. Negotiated Rate |
$3,758.40 |
| Rate for Payer: Aetna Commercial |
$3,014.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.70
|
| Rate for Payer: Cash Price |
$1,957.50
|
| Rate for Payer: Cigna Commercial |
$3,249.45
|
| Rate for Payer: First Health Commercial |
$3,719.25
|
| Rate for Payer: Humana Commercial |
$3,327.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,406.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.35
|
| Rate for Payer: PHCS Commercial |
$3,758.40
|
| Rate for Payer: United Healthcare All Payer |
$3,445.20
|
|
|
BLEPHAROPLASTY(LOW ONLY OR)-80
|
Facility
|
OP
|
$585.00
|
|
| Hospital Charge Code |
22200375
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem Medicaid |
$201.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Humana KY Medicaid |
$201.18
|
| Rate for Payer: Kentucky WC Medicaid |
$203.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.65
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
BLEPHAROPLASTY(LOW ONLY OR)-80
|
Facility
|
IP
|
$585.00
|
|
| Hospital Charge Code |
22200375
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$175.50 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$450.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$456.30
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$485.55
|
| Rate for Payer: First Health Commercial |
$555.75
|
| Rate for Payer: Humana Commercial |
$497.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.80
|
| Rate for Payer: Ohio Health Group HMO |
$438.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.65
|
| Rate for Payer: PHCS Commercial |
$561.60
|
| Rate for Payer: United Healthcare All Payer |
$514.80
|
|
|
BLEPHAROPLASTY(LOW ONLY OR)-80
|
Professional
|
Both
|
$585.00
|
|
| Hospital Charge Code |
22200375
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Multiplan PHCS |
$351.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.50
|
| Rate for Payer: UHCCP Medicaid |
$204.75
|
|
|
BLEPHAROPLASTY (UP ONLY IN OR)
|
Facility
|
IP
|
$600.00
|
|
| Hospital Charge Code |
22200039
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
BLEPHAROPLASTY (UP ONLY IN OR)
|
Professional
|
Both
|
$600.00
|
|
| Hospital Charge Code |
22200039
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
|
|
BLEPHAROPLASTY (UP ONLY IN OR)
|
Facility
|
OP
|
$600.00
|
|
| Hospital Charge Code |
22200039
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
BLEPHAROPLASTY(UP ONLY OR)-80
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
22200374
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
|
|
BLEPHAROPLASTY(UP ONLY OR)-80
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
22200374
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
BLEPHAROPLASTY(UP ONLY OR)-80
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
22200374
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
BLEPHAROPLASTY UPPER EYELID
|
Facility
|
OP
|
$5,695.00
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
76100216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$5,467.20 |
| Rate for Payer: Aetna Commercial |
$4,385.15
|
| Rate for Payer: Anthem Medicaid |
$1,958.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,442.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,847.50
|
| Rate for Payer: Cash Price |
$2,847.50
|
| Rate for Payer: Cigna Commercial |
$4,726.85
|
| Rate for Payer: First Health Commercial |
$5,410.25
|
| Rate for Payer: Humana Commercial |
$4,840.75
|
| Rate for Payer: Humana KY Medicaid |
$1,958.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,978.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,669.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,202.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,011.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,271.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,556.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,954.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,929.55
|
| Rate for Payer: PHCS Commercial |
$5,467.20
|
| Rate for Payer: United Healthcare All Payer |
$5,011.60
|
|
|
BLEPHAROPLASTY UPPER EYELID
|
Facility
|
IP
|
$5,695.00
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
76100216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,708.50 |
| Max. Negotiated Rate |
$5,467.20 |
| Rate for Payer: Aetna Commercial |
$4,385.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,442.10
|
| Rate for Payer: Cash Price |
$2,847.50
|
| Rate for Payer: Cigna Commercial |
$4,726.85
|
| Rate for Payer: First Health Commercial |
$5,410.25
|
| Rate for Payer: Humana Commercial |
$4,840.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,669.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,202.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,011.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,271.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,556.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,954.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,929.55
|
| Rate for Payer: PHCS Commercial |
$5,467.20
|
| Rate for Payer: United Healthcare All Payer |
$5,011.60
|
|
|
BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$5,695.00
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
76100216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.75 |
| Max. Negotiated Rate |
$3,417.00 |
| Rate for Payer: Aetna Commercial |
$845.31
|
| Rate for Payer: Ambetter Exchange |
$507.60
|
| Rate for Payer: Anthem Medicaid |
$416.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$507.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$507.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$609.12
|
| Rate for Payer: Cash Price |
$2,847.50
|
| Rate for Payer: Cash Price |
$2,847.50
|
| Rate for Payer: Cigna Commercial |
$812.80
|
| Rate for Payer: Healthspan PPO |
$731.11
|
| Rate for Payer: Humana Medicaid |
$416.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$686.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$507.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.08
|
| Rate for Payer: Molina Healthcare Passport |
$416.75
|
| Rate for Payer: Multiplan PHCS |
$3,417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$659.88
|
| Rate for Payer: UHCCP Medicaid |
$1,993.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$420.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$507.60
|
|
|
BLEPHAROPLASTY, UPPER EYELID
|
Facility
|
IP
|
$6,352.00
|
|
|
Service Code
|
HCPCS 15822
|
| Hospital Charge Code |
76100215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,905.60 |
| Max. Negotiated Rate |
$6,097.92 |
| Rate for Payer: Aetna Commercial |
$4,891.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,954.56
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Cigna Commercial |
$5,272.16
|
| Rate for Payer: First Health Commercial |
$6,034.40
|
| Rate for Payer: Humana Commercial |
$5,399.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,208.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,687.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,905.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,589.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,764.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,526.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,382.88
|
| Rate for Payer: PHCS Commercial |
$6,097.92
|
| Rate for Payer: United Healthcare All Payer |
$5,589.76
|
|
|
BLEPHAROPLASTY, UPPER EYELID
|
Professional
|
Both
|
$6,352.00
|
|
|
Service Code
|
HCPCS 15822
|
| Hospital Charge Code |
76100215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$3,811.20 |
| Rate for Payer: Aetna Commercial |
$515.24
|
| Rate for Payer: Ambetter Exchange |
$367.45
|
| Rate for Payer: Anthem Medicaid |
$285.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.94
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Cigna Commercial |
$504.96
|
| Rate for Payer: Healthspan PPO |
$462.48
|
| Rate for Payer: Humana Medicaid |
$285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$473.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.33
|
| Rate for Payer: Molina Healthcare Passport |
$285.62
|
| Rate for Payer: Multiplan PHCS |
$3,811.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.69
|
| Rate for Payer: UHCCP Medicaid |
$2,223.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.45
|
|
|
BLEPHAROPLASTY, UPPER EYELID
|
Facility
|
OP
|
$6,352.00
|
|
|
Service Code
|
HCPCS 15822
|
| Hospital Charge Code |
76100215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$6,097.92 |
| Rate for Payer: Aetna Commercial |
$4,891.04
|
| Rate for Payer: Anthem Medicaid |
$2,184.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,954.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Cigna Commercial |
$5,272.16
|
| Rate for Payer: First Health Commercial |
$6,034.40
|
| Rate for Payer: Humana Commercial |
$5,399.20
|
| Rate for Payer: Humana KY Medicaid |
$2,184.45
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,206.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,208.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,687.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,228.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,589.76
|
| Rate for Payer: Ohio Health Group HMO |
$4,764.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,081.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,526.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,382.88
|
| Rate for Payer: PHCS Commercial |
$6,097.92
|
| Rate for Payer: United Healthcare All Payer |
$5,589.76
|
|
|
BLEPHAROPLASTY UPPER EYELID(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
761P0216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.75 |
| Max. Negotiated Rate |
$845.31 |
| Rate for Payer: Aetna Commercial |
$845.31
|
| Rate for Payer: Ambetter Exchange |
$507.60
|
| Rate for Payer: Anthem Medicaid |
$416.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$507.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$507.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$609.12
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$812.80
|
| Rate for Payer: Healthspan PPO |
$731.11
|
| Rate for Payer: Humana Medicaid |
$416.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$686.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$507.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$425.08
|
| Rate for Payer: Molina Healthcare Passport |
$416.75
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$659.88
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$420.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$507.60
|
|
|
BLEPHAROPLASTY, UPPER EYELID(P
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
HCPCS 15822
|
| Hospital Charge Code |
761P0215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$515.24
|
| Rate for Payer: Ambetter Exchange |
$367.45
|
| Rate for Payer: Anthem Medicaid |
$285.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$367.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$367.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$440.94
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cash Price |
$690.00
|
| Rate for Payer: Cigna Commercial |
$504.96
|
| Rate for Payer: Healthspan PPO |
$462.48
|
| Rate for Payer: Humana Medicaid |
$285.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$473.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$367.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$367.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.33
|
| Rate for Payer: Molina Healthcare Passport |
$285.62
|
| Rate for Payer: Multiplan PHCS |
$828.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$477.69
|
| Rate for Payer: UHCCP Medicaid |
$483.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$367.45
|
|
|
BLEPHAROPLASTY UPPER EYELID(T
|
Facility
|
OP
|
$4,495.00
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
761T0216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,545.83 |
| Max. Negotiated Rate |
$4,315.20 |
| Rate for Payer: Aetna Commercial |
$3,461.15
|
| Rate for Payer: Anthem Medicaid |
$1,545.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cigna Commercial |
$3,730.85
|
| Rate for Payer: First Health Commercial |
$4,270.25
|
| Rate for Payer: Humana Commercial |
$3,820.75
|
| Rate for Payer: Humana KY Medicaid |
$1,545.83
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,561.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,685.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,317.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,955.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,910.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.55
|
| Rate for Payer: PHCS Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Payer |
$3,955.60
|
|
|
BLEPHAROPLASTY UPPER EYELID(T
|
Facility
|
IP
|
$4,495.00
|
|
|
Service Code
|
HCPCS 15823
|
| Hospital Charge Code |
761T0216
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,348.50 |
| Max. Negotiated Rate |
$4,315.20 |
| Rate for Payer: Aetna Commercial |
$3,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,506.10
|
| Rate for Payer: Cash Price |
$2,247.50
|
| Rate for Payer: Cigna Commercial |
$3,730.85
|
| Rate for Payer: First Health Commercial |
$4,270.25
|
| Rate for Payer: Humana Commercial |
$3,820.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,685.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,317.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,955.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,596.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,910.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,101.55
|
| Rate for Payer: PHCS Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Payer |
$3,955.60
|
|
|
BLEPHAROPLASTY, UPPER EYELID(T
|
Facility
|
IP
|
$4,972.00
|
|
|
Service Code
|
HCPCS 15822
|
| Hospital Charge Code |
761T0215
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,491.60 |
| Max. Negotiated Rate |
$4,773.12 |
| Rate for Payer: Aetna Commercial |
$3,828.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.16
|
| Rate for Payer: Cash Price |
$2,486.00
|
| Rate for Payer: Cigna Commercial |
$4,126.76
|
| Rate for Payer: First Health Commercial |
$4,723.40
|
| Rate for Payer: Humana Commercial |
$4,226.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,375.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,729.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,325.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,430.68
|
| Rate for Payer: PHCS Commercial |
$4,773.12
|
| Rate for Payer: United Healthcare All Payer |
$4,375.36
|
|
