|
CLOSURE OF EYELID BY SUTURE
|
Professional
|
Both
|
$3,892.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
76102392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$3,892.28 |
| Rate for Payer: Aetna Commercial |
$130.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$88.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,892.28
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cigna Commercial |
$126.14
|
| Rate for Payer: Healthspan PPO |
$198.42
|
| Rate for Payer: Humana Medicaid |
$88.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.69
|
| Rate for Payer: Molina Healthcare Passport |
$88.91
|
| Rate for Payer: Multiplan PHCS |
$2,335.37
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,724.60
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.80
|
|
|
CLOSURE OF EYELID BY SUTURE
|
Facility
|
IP
|
$3,892.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
76102392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.00 |
| Max. Negotiated Rate |
$3,736.59 |
| Rate for Payer: Aetna Commercial |
$2,997.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,035.98
|
| Rate for Payer: Cash Price |
$1,946.14
|
| Rate for Payer: Cigna Commercial |
$3,230.59
|
| Rate for Payer: First Health Commercial |
$3,697.67
|
| Rate for Payer: Humana Commercial |
$3,308.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,191.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,872.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,425.21
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.61
|
| Rate for Payer: PHCS Commercial |
$3,736.59
|
| Rate for Payer: United Healthcare All Payer |
$3,425.21
|
|
|
CLOSURE OF EYELID BY SUTURE(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
761P2392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$130.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.59
|
| Rate for Payer: Anthem Medicaid |
$88.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$126.14
|
| Rate for Payer: Healthspan PPO |
$198.42
|
| Rate for Payer: Humana Medicaid |
$88.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$123.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.69
|
| Rate for Payer: Molina Healthcare Passport |
$88.91
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$49.97
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.80
|
|
|
CLOSURE OF EYELID BY SUTURE(T
|
Facility
|
OP
|
$3,112.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
761T2392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$2,987.79 |
| Rate for Payer: Aetna Commercial |
$2,396.46
|
| Rate for Payer: Anthem Medicaid |
$1,070.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$875.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,427.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,225.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,181.94
|
| Rate for Payer: Cash Price |
$1,556.14
|
| Rate for Payer: Cash Price |
$1,556.14
|
| Rate for Payer: Cigna Commercial |
$2,583.19
|
| Rate for Payer: First Health Commercial |
$2,956.67
|
| Rate for Payer: Humana Commercial |
$2,645.44
|
| Rate for Payer: Humana KY Medicaid |
$1,070.31
|
| Rate for Payer: Humana Medicare Advantage |
$875.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,081.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,552.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,050.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,091.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,738.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,334.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.81
|
| Rate for Payer: PHCS Commercial |
$2,987.79
|
| Rate for Payer: United Healthcare All Payer |
$2,738.81
|
|
|
CLOSURE OF EYELID BY SUTURE(T
|
Facility
|
IP
|
$3,112.28
|
|
|
Service Code
|
HCPCS 67875
|
| Hospital Charge Code |
761T2392
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$404.60 |
| Max. Negotiated Rate |
$2,987.79 |
| Rate for Payer: Aetna Commercial |
$2,396.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,427.58
|
| Rate for Payer: Cash Price |
$1,556.14
|
| Rate for Payer: Cigna Commercial |
$2,583.19
|
| Rate for Payer: First Health Commercial |
$2,956.67
|
| Rate for Payer: Humana Commercial |
$2,645.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,552.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,296.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,738.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,334.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.81
|
| Rate for Payer: PHCS Commercial |
$2,987.79
|
| Rate for Payer: United Healthcare All Payer |
$2,738.81
|
|
|
CLOSURE OF MEDIAN STERNOTOMY
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21750
|
| Hospital Charge Code |
76100406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CLOSURE OF MEDIAN STERNOTOMY
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21750
|
| Hospital Charge Code |
76100406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
CLOSURE OF MEDIAN STERNOTOMY
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21750
|
| Hospital Charge Code |
76100406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$526.84 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,078.46
|
| Rate for Payer: Anthem Medicaid |
$526.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,156.14
|
| Rate for Payer: Healthspan PPO |
$976.85
|
| Rate for Payer: Humana Medicaid |
$526.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$902.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$537.38
|
| Rate for Payer: Molina Healthcare Passport |
$526.84
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$532.11
|
|
|
CLOSURE OF MEDIAN STERNOTOMY(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 21750
|
| Hospital Charge Code |
761P0406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$526.84 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,078.46
|
| Rate for Payer: Anthem Medicaid |
$526.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,156.14
|
| Rate for Payer: Healthspan PPO |
$976.85
|
| Rate for Payer: Humana Medicaid |
$526.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$902.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$537.38
|
| Rate for Payer: Molina Healthcare Passport |
$526.84
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$532.11
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$270.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.52
|
| Rate for Payer: Anthem Medicaid |
$111.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,092.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$366.47
|
| Rate for Payer: Healthspan PPO |
$296.42
|
| Rate for Payer: Humana Medicaid |
$111.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.93
|
| Rate for Payer: Molina Healthcare Passport |
$111.70
|
| Rate for Payer: Multiplan PHCS |
$655.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$764.40
|
| Rate for Payer: UHCCP Medicaid |
$100.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.82
|
|
|
CLOSURE OF SPLIT WOUND
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12021
|
| Hospital Charge Code |
76102750
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.51 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$196.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.81
|
| Rate for Payer: Anthem Medicaid |
$63.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$213.10
|
| Rate for Payer: Healthspan PPO |
$178.27
|
| Rate for Payer: Humana Medicaid |
$63.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$169.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.78
|
| Rate for Payer: Molina Healthcare Passport |
$63.51
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.15
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$1,048.32 |
| Rate for Payer: Aetna Commercial |
$840.84
|
| Rate for Payer: Anthem Medicaid |
$375.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$906.36
|
| Rate for Payer: First Health Commercial |
$1,037.40
|
| Rate for Payer: Humana Commercial |
$928.20
|
| Rate for Payer: Humana KY Medicaid |
$375.54
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$379.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.96
|
| Rate for Payer: Ohio Health Group HMO |
$819.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.52
|
| Rate for Payer: PHCS Commercial |
$1,048.32
|
| Rate for Payer: United Healthcare All Payer |
$960.96
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
76100133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.96 |
| Max. Negotiated Rate |
$1,048.32 |
| Rate for Payer: Aetna Commercial |
$840.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.76
|
| Rate for Payer: Cash Price |
$546.00
|
| Rate for Payer: Cigna Commercial |
$906.36
|
| Rate for Payer: First Health Commercial |
$1,037.40
|
| Rate for Payer: Humana Commercial |
$928.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.96
|
| Rate for Payer: Ohio Health Group HMO |
$819.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.52
|
| Rate for Payer: PHCS Commercial |
$1,048.32
|
| Rate for Payer: United Healthcare All Payer |
$960.96
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
CLOSURE OF SPLIT WOUND
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
45000054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
CLOSURE OF SPLIT WOUND(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
761P0133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$366.47 |
| Rate for Payer: Aetna Commercial |
$270.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$95.52
|
| Rate for Payer: Anthem Medicaid |
$111.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$366.47
|
| Rate for Payer: Healthspan PPO |
$296.42
|
| Rate for Payer: Humana Medicaid |
$111.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$230.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$113.93
|
| Rate for Payer: Molina Healthcare Passport |
$111.70
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$100.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$112.82
|
|
|
CLOSURE OF SPLIT WOUND(T
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
761T0133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
CLOSURE OF SPLIT WOUND(T
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
761T0133
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.46 |
| Max. Negotiated Rate |
$760.35 |
| Rate for Payer: Aetna Commercial |
$571.34
|
| Rate for Payer: Anthem Medicaid |
$255.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$578.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.20
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cash Price |
$371.00
|
| Rate for Payer: Cigna Commercial |
$615.86
|
| Rate for Payer: First Health Commercial |
$704.90
|
| Rate for Payer: Humana Commercial |
$630.70
|
| Rate for Payer: Humana KY Medicaid |
$255.17
|
| Rate for Payer: Humana Medicare Advantage |
$543.11
|
| Rate for Payer: Kentucky WC Medicaid |
$257.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$608.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$547.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$260.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$652.96
|
| Rate for Payer: Ohio Health Group HMO |
$556.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$148.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$230.02
|
| Rate for Payer: PHCS Commercial |
$712.32
|
| Rate for Payer: United Healthcare All Payer |
$652.96
|
|
|
CLOT TRIEVER BOLD CATH.
|
Facility
|
OP
|
$30,350.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,945.50 |
| Max. Negotiated Rate |
$29,136.00 |
| Rate for Payer: Aetna Commercial |
$23,369.50
|
| Rate for Payer: Anthem Medicaid |
$10,437.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,673.00
|
| Rate for Payer: Cash Price |
$15,175.00
|
| Rate for Payer: Cigna Commercial |
$25,190.50
|
| Rate for Payer: First Health Commercial |
$28,832.50
|
| Rate for Payer: Humana Commercial |
$25,797.50
|
| Rate for Payer: Humana KY Medicaid |
$10,437.36
|
| Rate for Payer: Kentucky WC Medicaid |
$10,543.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,887.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,398.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,105.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,646.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,945.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,408.50
|
| Rate for Payer: PHCS Commercial |
$29,136.00
|
| Rate for Payer: United Healthcare All Payer |
$26,708.00
|
|
|
CLOT TRIEVER BOLD CATH.
|
Facility
|
IP
|
$30,350.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,945.50 |
| Max. Negotiated Rate |
$29,136.00 |
| Rate for Payer: Aetna Commercial |
$23,369.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,673.00
|
| Rate for Payer: Cash Price |
$15,175.00
|
| Rate for Payer: Cigna Commercial |
$25,190.50
|
| Rate for Payer: First Health Commercial |
$28,832.50
|
| Rate for Payer: Humana Commercial |
$25,797.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,887.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,398.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,945.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,408.50
|
| Rate for Payer: PHCS Commercial |
$29,136.00
|
| Rate for Payer: United Healthcare All Payer |
$26,708.00
|
|
|
CLOT TRIEVER CATHETER
|
Facility
|
IP
|
$30,350.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,945.50 |
| Max. Negotiated Rate |
$29,136.00 |
| Rate for Payer: Aetna Commercial |
$23,369.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,673.00
|
| Rate for Payer: Cash Price |
$15,175.00
|
| Rate for Payer: Cigna Commercial |
$25,190.50
|
| Rate for Payer: First Health Commercial |
$28,832.50
|
| Rate for Payer: Humana Commercial |
$25,797.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,887.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,398.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,945.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,408.50
|
| Rate for Payer: PHCS Commercial |
$29,136.00
|
| Rate for Payer: United Healthcare All Payer |
$26,708.00
|
|
|
CLOT TRIEVER CATHETER
|
Facility
|
OP
|
$30,350.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,945.50 |
| Max. Negotiated Rate |
$29,136.00 |
| Rate for Payer: Aetna Commercial |
$23,369.50
|
| Rate for Payer: Anthem Medicaid |
$10,437.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23,673.00
|
| Rate for Payer: Cash Price |
$15,175.00
|
| Rate for Payer: Cigna Commercial |
$25,190.50
|
| Rate for Payer: First Health Commercial |
$28,832.50
|
| Rate for Payer: Humana Commercial |
$25,797.50
|
| Rate for Payer: Humana KY Medicaid |
$10,437.36
|
| Rate for Payer: Kentucky WC Medicaid |
$10,543.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,887.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,398.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,105.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,646.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$26,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,945.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,408.50
|
| Rate for Payer: PHCS Commercial |
$29,136.00
|
| Rate for Payer: United Healthcare All Payer |
$26,708.00
|
|
|
CLOT TRIEVER SHEATH
|
Facility
|
IP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
CLOT TRIEVER SHEATH
|
Facility
|
OP
|
$10,600.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,378.00 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$8,162.00
|
| Rate for Payer: Anthem Medicaid |
$3,645.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,268.00
|
| Rate for Payer: Cash Price |
$5,300.00
|
| Rate for Payer: Cigna Commercial |
$8,798.00
|
| Rate for Payer: First Health Commercial |
$10,070.00
|
| Rate for Payer: Humana Commercial |
$9,010.00
|
| Rate for Payer: Humana KY Medicaid |
$3,645.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,682.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,692.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,822.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,180.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,718.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,328.00
|
| Rate for Payer: Ohio Health Group HMO |
$7,950.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,378.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,286.00
|
| Rate for Payer: PHCS Commercial |
$10,176.00
|
| Rate for Payer: United Healthcare All Payer |
$9,328.00
|
|
|
CLOZAPINE
|
Facility
|
OP
|
$9.67
|
|
|
Service Code
|
NDC 60687041501
|
| Hospital Charge Code |
25000437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem Medicaid |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.54
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.19
|
| Rate for Payer: Humana Commercial |
$8.22
|
| Rate for Payer: Humana KY Medicaid |
$3.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.51
|
| Rate for Payer: Ohio Health Group HMO |
$7.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.00
|
| Rate for Payer: PHCS Commercial |
$9.28
|
| Rate for Payer: United Healthcare All Payer |
$8.51
|
|
