|
CLAVICLE LT COMPLETE
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
32000072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.30 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.10
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
CLAVICLE LT COMPLETE(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320P0072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.74
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
|
|
CLAVICLE LT COMPLETE(T
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320T0072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
CLAVICLE LT COMPLETE(T
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS 73000
|
| Hospital Charge Code |
320T0072
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem Medicaid |
$89.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Humana KY Medicaid |
$89.41
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$90.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.60
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 23120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
CLAVICULECTOMY; PARTIAL
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
|
CLAVICULECTOMY; PARTIAL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
76100445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.76 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Anthem Medicaid |
$336.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Healthspan PPO |
$755.99
|
| Rate for Payer: Humana Medicaid |
$336.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$714.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.50
|
| Rate for Payer: Molina Healthcare Passport |
$336.76
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.13
|
|
|
CLAVICULECTOMY; PARTIAL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 23120
|
| Hospital Charge Code |
761P0445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.76 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$834.62
|
| Rate for Payer: Anthem Medicaid |
$336.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Healthspan PPO |
$755.99
|
| Rate for Payer: Humana Medicaid |
$336.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$714.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$343.50
|
| Rate for Payer: Molina Healthcare Passport |
$336.76
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$340.13
|
|
|
CLAVICULECTOMY; TOTAL
|
Facility
|
OP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.60 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,863.40
|
| Rate for Payer: Anthem Medicaid |
$832.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,887.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$2,008.60
|
| Rate for Payer: First Health Commercial |
$2,299.00
|
| Rate for Payer: Humana Commercial |
$2,057.00
|
| Rate for Payer: Humana KY Medicaid |
$832.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$840.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,984.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,785.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$848.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,129.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$750.20
|
| Rate for Payer: PHCS Commercial |
$2,323.20
|
| Rate for Payer: United Healthcare All Payer |
$2,129.60
|
|
|
CLAVICULECTOMY; TOTAL
|
Facility
|
IP
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.60 |
| Max. Negotiated Rate |
$2,323.20 |
| Rate for Payer: Aetna Commercial |
$1,863.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,887.60
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$2,008.60
|
| Rate for Payer: First Health Commercial |
$2,299.00
|
| Rate for Payer: Humana Commercial |
$2,057.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,984.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,785.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$726.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,129.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,815.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$750.20
|
| Rate for Payer: PHCS Commercial |
$2,323.20
|
| Rate for Payer: United Healthcare All Payer |
$2,129.60
|
|
|
CLAVICULECTOMY; TOTAL
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
76100446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.74 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna Commercial |
$1,032.58
|
| Rate for Payer: Anthem Medicaid |
$519.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,420.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$1,128.27
|
| Rate for Payer: Healthspan PPO |
$935.29
|
| Rate for Payer: Humana Medicaid |
$519.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$873.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.13
|
| Rate for Payer: Molina Healthcare Passport |
$519.74
|
| Rate for Payer: Multiplan PHCS |
$1,452.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,694.00
|
| Rate for Payer: UHCCP Medicaid |
$847.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.94
|
|
|
CLAVICULECTOMY; TOTAL(P
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 23125
|
| Hospital Charge Code |
761P0446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$519.74 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna Commercial |
$1,032.58
|
| Rate for Payer: Anthem Medicaid |
$519.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,420.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cash Price |
$1,210.00
|
| Rate for Payer: Cigna Commercial |
$1,128.27
|
| Rate for Payer: Healthspan PPO |
$935.29
|
| Rate for Payer: Humana Medicaid |
$519.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$873.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$530.13
|
| Rate for Payer: Molina Healthcare Passport |
$519.74
|
| Rate for Payer: Multiplan PHCS |
$1,452.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,694.00
|
| Rate for Payer: UHCCP Medicaid |
$847.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$524.94
|
|
|
CLEANER 6F 135CM
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
CLEANER 6F 135CM
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
CLEAN OUT MASTOID CAVITY
|
Facility
|
OP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
76102415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.24 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem Medicaid |
$773.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Humana KY Medicaid |
$773.09
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$780.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$788.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.88
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLEAN OUT MASTOID CAVITY
|
Facility
|
IP
|
$2,248.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
76102415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.24 |
| Max. Negotiated Rate |
$2,158.08 |
| Rate for Payer: Aetna Commercial |
$1,730.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,753.44
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$1,865.84
|
| Rate for Payer: First Health Commercial |
$2,135.60
|
| Rate for Payer: Humana Commercial |
$1,910.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,843.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,659.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,978.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,686.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$449.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.88
|
| Rate for Payer: PHCS Commercial |
$2,158.08
|
| Rate for Payer: United Healthcare All Payer |
$1,978.24
|
|
|
CLEAN OUT MASTOID CAVITY
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
76102415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$2,248.00 |
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.08
|
| Rate for Payer: Anthem Medicaid |
$51.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,248.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cash Price |
$1,124.00
|
| Rate for Payer: Cigna Commercial |
$300.09
|
| Rate for Payer: Healthspan PPO |
$265.45
|
| Rate for Payer: Humana Medicaid |
$51.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.51
|
| Rate for Payer: Molina Healthcare Passport |
$51.48
|
| Rate for Payer: Multiplan PHCS |
$1,348.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,573.60
|
| Rate for Payer: UHCCP Medicaid |
$73.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.99
|
|
|
CLEAN OUT MASTOID CAVITY(P
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
761P2415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$194.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$70.08
|
| Rate for Payer: Anthem Medicaid |
$51.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$475.00
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$300.09
|
| Rate for Payer: Healthspan PPO |
$265.45
|
| Rate for Payer: Humana Medicaid |
$51.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$174.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.51
|
| Rate for Payer: Molina Healthcare Passport |
$51.48
|
| Rate for Payer: Multiplan PHCS |
$285.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.50
|
| Rate for Payer: UHCCP Medicaid |
$73.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.99
|
|
|
CLEAN OUT MASTOID CAVITY(T
|
Facility
|
IP
|
$1,773.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
761T2415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.49 |
| Max. Negotiated Rate |
$1,702.08 |
| Rate for Payer: Aetna Commercial |
$1,365.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.94
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$1,471.59
|
| Rate for Payer: First Health Commercial |
$1,684.35
|
| Rate for Payer: Humana Commercial |
$1,507.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.63
|
| Rate for Payer: PHCS Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare All Payer |
$1,560.24
|
|
|
CLEAN OUT MASTOID CAVITY(T
|
Facility
|
OP
|
$1,773.00
|
|
|
Service Code
|
HCPCS 69222
|
| Hospital Charge Code |
761T2415
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$230.49 |
| Max. Negotiated Rate |
$1,702.08 |
| Rate for Payer: Aetna Commercial |
$1,365.21
|
| Rate for Payer: Anthem Medicaid |
$609.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$1,471.59
|
| Rate for Payer: First Health Commercial |
$1,684.35
|
| Rate for Payer: Humana Commercial |
$1,507.05
|
| Rate for Payer: Humana KY Medicaid |
$609.73
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$615.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.63
|
| Rate for Payer: PHCS Commercial |
$1,702.08
|
| Rate for Payer: United Healthcare All Payer |
$1,560.24
|
|
|
CLEAN ROUTINE
|
Professional
|
Both
|
$32.00
|
|
| Hospital Charge Code |
22200120
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$32.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Multiplan PHCS |
$19.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$22.40
|
| Rate for Payer: UHCCP Medicaid |
$11.20
|
|
|
CLEOCIN(CLINDAMYCIN 150MG/1CAP
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 42571025101
|
| Hospital Charge Code |
25000427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
|
|
CLEOCIN(CLINDAMYCIN 150MG/1CAP
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 42571025101
|
| Hospital Charge Code |
25000427
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
