|
CLOSED TX VERT FX W/MANJ(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
761P0420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.90 |
| Max. Negotiated Rate |
$1,172.62 |
| Rate for Payer: Aetna Commercial |
$1,104.28
|
| Rate for Payer: Ambetter Exchange |
$746.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$414.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$746.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$746.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$896.09
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,172.62
|
| Rate for Payer: Healthspan PPO |
$1,112.70
|
| Rate for Payer: Humana Medicaid |
$414.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$746.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$746.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.28
|
| Rate for Payer: Molina Healthcare Passport |
$414.00
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$970.76
|
| Rate for Payer: UHCCP Medicaid |
$415.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$746.74
|
|
|
CLOSED TX VERT FX W/MANJ(T
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
761T0420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,176.30 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLOSED TX VERT FX W/MANJ(T
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
761T0420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,348.43 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,136.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,411.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,705.49
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
76100419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$1,391.04 |
| Rate for Payer: Aetna Commercial |
$1,115.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,130.22
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna Commercial |
$1,202.67
|
| Rate for Payer: First Health Commercial |
$1,376.55
|
| Rate for Payer: Humana Commercial |
$1,231.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,188.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,069.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$434.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,275.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,086.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$999.81
|
| Rate for Payer: PHCS Commercial |
$1,391.04
|
| Rate for Payer: United Healthcare All Payer |
$1,275.12
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
76100419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,391.04 |
| Rate for Payer: Aetna Commercial |
$1,115.73
|
| Rate for Payer: Anthem Medicaid |
$498.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,130.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna Commercial |
$1,202.67
|
| Rate for Payer: First Health Commercial |
$1,376.55
|
| Rate for Payer: Humana Commercial |
$1,231.65
|
| Rate for Payer: Humana KY Medicaid |
$498.31
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$503.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,188.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,069.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,275.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,086.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,260.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$999.81
|
| Rate for Payer: PHCS Commercial |
$1,391.04
|
| Rate for Payer: United Healthcare All Payer |
$1,275.12
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
76100419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$383.49
|
| Rate for Payer: Ambetter Exchange |
$283.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$152.96
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$283.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.18
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna Commercial |
$431.26
|
| Rate for Payer: Healthspan PPO |
$370.14
|
| Rate for Payer: Humana Medicaid |
$138.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$344.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$283.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.72
|
| Rate for Payer: Molina Healthcare Passport |
$138.94
|
| Rate for Payer: Multiplan PHCS |
$869.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$368.52
|
| Rate for Payer: UHCCP Medicaid |
$160.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.48
|
|
|
CLOSED TX VERT FX W/O MANJ(P
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
761P0419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: Aetna Commercial |
$383.49
|
| Rate for Payer: Ambetter Exchange |
$283.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$152.96
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$283.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$283.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.18
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$431.26
|
| Rate for Payer: Healthspan PPO |
$370.14
|
| Rate for Payer: Humana Medicaid |
$138.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$344.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$283.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.72
|
| Rate for Payer: Molina Healthcare Passport |
$138.94
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$368.52
|
| Rate for Payer: UHCCP Medicaid |
$160.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$283.48
|
|
|
CLOSED TX VERT FX W/O MANJ(T
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
761T0419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$695.04 |
| Rate for Payer: Aetna Commercial |
$557.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.72
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$600.92
|
| Rate for Payer: First Health Commercial |
$687.80
|
| Rate for Payer: Humana Commercial |
$615.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$593.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$534.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$637.12
|
| Rate for Payer: Ohio Health Group HMO |
$543.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$579.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$499.56
|
| Rate for Payer: PHCS Commercial |
$695.04
|
| Rate for Payer: United Healthcare All Payer |
$637.12
|
|
|
CLOSED TX VERT FX W/O MANJ(T
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
761T0419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$695.04 |
| Rate for Payer: Aetna Commercial |
$557.48
|
| Rate for Payer: Anthem Medicaid |
$248.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$600.92
|
| Rate for Payer: First Health Commercial |
$687.80
|
| Rate for Payer: Humana Commercial |
$615.40
|
| Rate for Payer: Humana KY Medicaid |
$248.98
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$251.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$593.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$534.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$253.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$637.12
|
| Rate for Payer: Ohio Health Group HMO |
$543.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$579.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$499.56
|
| Rate for Payer: PHCS Commercial |
$695.04
|
| Rate for Payer: United Healthcare All Payer |
$637.12
|
|
|
CLOSE MASTOID FISTULA
|
Facility
|
OP
|
$3,678.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
76102436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,264.86 |
| Max. Negotiated Rate |
$3,530.88 |
| Rate for Payer: Aetna Commercial |
$2,832.06
|
| Rate for Payer: Anthem Medicaid |
$1,264.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,868.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cigna Commercial |
$3,052.74
|
| Rate for Payer: First Health Commercial |
$3,494.10
|
| Rate for Payer: Humana Commercial |
$3,126.30
|
| Rate for Payer: Humana KY Medicaid |
$1,264.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,015.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,714.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,290.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,236.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,758.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,942.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,199.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.82
|
| Rate for Payer: PHCS Commercial |
$3,530.88
|
| Rate for Payer: United Healthcare All Payer |
$3,236.64
|
|
|
CLOSE MASTOID FISTULA
|
Facility
|
IP
|
$3,678.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
76102436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,103.40 |
| Max. Negotiated Rate |
$3,530.88 |
| Rate for Payer: Aetna Commercial |
$2,832.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,868.84
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cigna Commercial |
$3,052.74
|
| Rate for Payer: First Health Commercial |
$3,494.10
|
| Rate for Payer: Humana Commercial |
$3,126.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,015.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,714.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,103.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,236.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,758.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,942.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,199.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,537.82
|
| Rate for Payer: PHCS Commercial |
$3,530.88
|
| Rate for Payer: United Healthcare All Payer |
$3,236.64
|
|
|
CLOSE MASTOID FISTULA
|
Professional
|
Both
|
$3,678.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
76102436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.10 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Aetna Commercial |
$987.61
|
| Rate for Payer: Ambetter Exchange |
$618.30
|
| Rate for Payer: Anthem Medicaid |
$465.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$618.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$618.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$741.96
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cigna Commercial |
$992.16
|
| Rate for Payer: Healthspan PPO |
$876.05
|
| Rate for Payer: Humana Medicaid |
$465.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$881.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$618.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.40
|
| Rate for Payer: Molina Healthcare Passport |
$465.10
|
| Rate for Payer: Multiplan PHCS |
$2,206.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$803.79
|
| Rate for Payer: UHCCP Medicaid |
$1,287.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$618.30
|
|
|
CLOSE MASTOID FISTULA(P
|
Professional
|
Both
|
$1,745.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
761P2436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.10 |
| Max. Negotiated Rate |
$1,047.00 |
| Rate for Payer: Aetna Commercial |
$987.61
|
| Rate for Payer: Ambetter Exchange |
$618.30
|
| Rate for Payer: Anthem Medicaid |
$465.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$618.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$618.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$741.96
|
| Rate for Payer: Cash Price |
$872.50
|
| Rate for Payer: Cash Price |
$872.50
|
| Rate for Payer: Cigna Commercial |
$992.16
|
| Rate for Payer: Healthspan PPO |
$876.05
|
| Rate for Payer: Humana Medicaid |
$465.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$881.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$618.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.40
|
| Rate for Payer: Molina Healthcare Passport |
$465.10
|
| Rate for Payer: Multiplan PHCS |
$1,047.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$803.79
|
| Rate for Payer: UHCCP Medicaid |
$610.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$618.30
|
|
|
CLOSE MASTOID FISTULA(T
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
761T2436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.76 |
| Max. Negotiated Rate |
$1,916.14 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.77
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
CLOSE MASTOID FISTULA(T
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
761T2436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$579.90 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.77
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
CLOS ENTER - W CLOSURE ANASTO
|
Facility
|
OP
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
76101861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$659.70 |
| Max. Negotiated Rate |
$2,111.04 |
| Rate for Payer: Aetna Commercial |
$1,693.23
|
| Rate for Payer: Anthem Medicaid |
$756.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.22
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$1,825.17
|
| Rate for Payer: First Health Commercial |
$2,089.05
|
| Rate for Payer: Humana Commercial |
$1,869.15
|
| Rate for Payer: Humana KY Medicaid |
$756.24
|
| Rate for Payer: Kentucky WC Medicaid |
$763.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,622.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,759.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,913.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,517.31
|
| Rate for Payer: PHCS Commercial |
$2,111.04
|
| Rate for Payer: United Healthcare All Payer |
$1,935.12
|
|
|
CLOS ENTER - W CLOSURE ANASTO
|
Facility
|
IP
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
76101861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$659.70 |
| Max. Negotiated Rate |
$2,111.04 |
| Rate for Payer: Aetna Commercial |
$1,693.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.22
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$1,825.17
|
| Rate for Payer: First Health Commercial |
$2,089.05
|
| Rate for Payer: Humana Commercial |
$1,869.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,622.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,759.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,913.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,517.31
|
| Rate for Payer: PHCS Commercial |
$2,111.04
|
| Rate for Payer: United Healthcare All Payer |
$1,935.12
|
|
|
CLOS ENTER - W CLOSURE ANASTO
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
76101861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.65 |
| Max. Negotiated Rate |
$2,347.26 |
| Rate for Payer: Aetna Commercial |
$2,347.26
|
| Rate for Payer: Ambetter Exchange |
$1,506.50
|
| Rate for Payer: Anthem Medicaid |
$1,002.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,506.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,506.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,807.80
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$2,192.44
|
| Rate for Payer: Healthspan PPO |
$1,979.49
|
| Rate for Payer: Humana Medicaid |
$1,002.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,506.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,022.58
|
| Rate for Payer: Molina Healthcare Passport |
$1,002.53
|
| Rate for Payer: Multiplan PHCS |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,958.45
|
| Rate for Payer: UHCCP Medicaid |
$769.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,012.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,506.50
|
|
|
CLOS ENTER - W CLOSURE ANAST(P
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
761P1861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.65 |
| Max. Negotiated Rate |
$2,347.26 |
| Rate for Payer: Aetna Commercial |
$2,347.26
|
| Rate for Payer: Ambetter Exchange |
$1,506.50
|
| Rate for Payer: Anthem Medicaid |
$1,002.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,506.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,506.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,807.80
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$2,192.44
|
| Rate for Payer: Healthspan PPO |
$1,979.49
|
| Rate for Payer: Humana Medicaid |
$1,002.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,506.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,022.58
|
| Rate for Payer: Molina Healthcare Passport |
$1,002.53
|
| Rate for Payer: Multiplan PHCS |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,958.45
|
| Rate for Payer: UHCCP Medicaid |
$769.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,012.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,506.50
|
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Facility
|
OP
|
$1,845.00
|
|
|
Service Code
|
HCPCS 43870
|
| Hospital Charge Code |
76101800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.50 |
| Max. Negotiated Rate |
$4,921.43 |
| Rate for Payer: Aetna Commercial |
$1,420.65
|
| Rate for Payer: Anthem Medicaid |
$634.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,515.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,921.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,745.67
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna Commercial |
$1,531.35
|
| Rate for Payer: First Health Commercial |
$1,752.75
|
| Rate for Payer: Humana Commercial |
$1,568.25
|
| Rate for Payer: Humana KY Medicaid |
$634.50
|
| Rate for Payer: Humana Medicare Advantage |
$3,515.31
|
| Rate for Payer: Kentucky WC Medicaid |
$640.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,605.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,273.05
|
| Rate for Payer: PHCS Commercial |
$1,771.20
|
| Rate for Payer: United Healthcare All Payer |
$1,623.60
|
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Professional
|
Both
|
$1,845.00
|
|
|
Service Code
|
HCPCS 43870
|
| Hospital Charge Code |
76101800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.96 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Aetna Commercial |
$1,009.54
|
| Rate for Payer: Ambetter Exchange |
$675.30
|
| Rate for Payer: Anthem Medicaid |
$374.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$810.36
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna Commercial |
$931.23
|
| Rate for Payer: Healthspan PPO |
$851.36
|
| Rate for Payer: Humana Medicaid |
$374.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$901.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$382.46
|
| Rate for Payer: Molina Healthcare Passport |
$374.96
|
| Rate for Payer: Multiplan PHCS |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.89
|
| Rate for Payer: UHCCP Medicaid |
$645.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$378.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.30
|
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Professional
|
Both
|
$1,845.00
|
|
|
Service Code
|
HCPCS 43870
|
| Hospital Charge Code |
761P1800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.96 |
| Max. Negotiated Rate |
$1,107.00 |
| Rate for Payer: Aetna Commercial |
$1,009.54
|
| Rate for Payer: Ambetter Exchange |
$675.30
|
| Rate for Payer: Anthem Medicaid |
$374.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$675.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$675.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$810.36
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna Commercial |
$931.23
|
| Rate for Payer: Healthspan PPO |
$851.36
|
| Rate for Payer: Humana Medicaid |
$374.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$901.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$675.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$382.46
|
| Rate for Payer: Molina Healthcare Passport |
$374.96
|
| Rate for Payer: Multiplan PHCS |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$877.89
|
| Rate for Payer: UHCCP Medicaid |
$645.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$378.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$675.30
|
|
|
CLOSE OF GASTROSTOMY, SURGICAL
|
Facility
|
IP
|
$1,845.00
|
|
|
Service Code
|
HCPCS 43870
|
| Hospital Charge Code |
76101800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.50 |
| Max. Negotiated Rate |
$1,771.20 |
| Rate for Payer: Aetna Commercial |
$1,420.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna Commercial |
$1,531.35
|
| Rate for Payer: First Health Commercial |
$1,752.75
|
| Rate for Payer: Humana Commercial |
$1,568.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,605.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,273.05
|
| Rate for Payer: PHCS Commercial |
$1,771.20
|
| Rate for Payer: United Healthcare All Payer |
$1,623.60
|
|
|
CLOSE OF RECTOVAGINAL FISTULA
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
76102189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
CLOSE OF RECTOVAGINAL FISTULA
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 57305
|
| Hospital Charge Code |
76102189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
