|
EXC GANGLION - WRIST(P
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
761P0582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$662.00 |
| Rate for Payer: Aetna Commercial |
$446.12
|
| Rate for Payer: Anthem Medicaid |
$194.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$662.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$523.81
|
| Rate for Payer: Healthspan PPO |
$404.09
|
| Rate for Payer: Humana Medicaid |
$194.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.70
|
| Rate for Payer: Molina Healthcare Passport |
$194.80
|
| Rate for Payer: Multiplan PHCS |
$397.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$463.40
|
| Rate for Payer: UHCCP Medicaid |
$231.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.75
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
76100666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.01 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna Commercial |
$628.27
|
| Rate for Payer: Anthem Medicaid |
$297.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: Healthspan PPO |
$447.73
|
| Rate for Payer: Humana Medicaid |
$297.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.95
|
| Rate for Payer: Molina Healthcare Passport |
$297.01
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.98
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
76100666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
76100666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$317.75
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
EXC HAND LES SC 1.5 CM/>(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
761P0666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.01 |
| Max. Negotiated Rate |
$1,025.00 |
| Rate for Payer: Aetna Commercial |
$628.27
|
| Rate for Payer: Anthem Medicaid |
$297.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,025.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: Healthspan PPO |
$447.73
|
| Rate for Payer: Humana Medicaid |
$297.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.95
|
| Rate for Payer: Molina Healthcare Passport |
$297.01
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$717.50
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.98
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
76100669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
76100669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$680.16
|
| Rate for Payer: Anthem Medicaid |
$266.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$754.90
|
| Rate for Payer: Healthspan PPO |
$616.08
|
| Rate for Payer: Humana Medicaid |
$266.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.21
|
| Rate for Payer: Molina Healthcare Passport |
$266.87
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.54
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
76100669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.50 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$162.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$387.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
76100667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.87 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$826.28
|
| Rate for Payer: Anthem Medicaid |
$390.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,275.00
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$944.92
|
| Rate for Payer: Healthspan PPO |
$588.82
|
| Rate for Payer: Humana Medicaid |
$390.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$691.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.69
|
| Rate for Payer: Molina Healthcare Passport |
$390.87
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.50
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.78
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
76100667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.25
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
76100667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.75 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.25
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXC HAND TUM DEEP < 1.5 CM(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
761P0669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Aetna Commercial |
$680.16
|
| Rate for Payer: Anthem Medicaid |
$266.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,250.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$754.90
|
| Rate for Payer: Healthspan PPO |
$616.08
|
| Rate for Payer: Humana Medicaid |
$266.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.21
|
| Rate for Payer: Molina Healthcare Passport |
$266.87
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$875.00
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.54
|
|
|
EXC HAND TUM DEEP 1.5 CM/>(P
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
761P0667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.87 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$826.28
|
| Rate for Payer: Anthem Medicaid |
$390.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,275.00
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$944.92
|
| Rate for Payer: Healthspan PPO |
$588.82
|
| Rate for Payer: Humana Medicaid |
$390.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$691.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.69
|
| Rate for Payer: Molina Healthcare Passport |
$390.87
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$892.50
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.78
|
|
|
EXCHANGE BILIARY DRAIN CATH(P
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
761P1960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.94
|
| Rate for Payer: Anthem Medicaid |
$121.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna Commercial |
$246.96
|
| Rate for Payer: Humana Medicaid |
$121.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.50
|
| Rate for Payer: Molina Healthcare Passport |
$121.08
|
| Rate for Payer: Multiplan PHCS |
$415.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$484.40
|
| Rate for Payer: UHCCP Medicaid |
$125.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.29
|
|
|
EXCHANGE JEJUNOSTOMY TUBE
|
Facility
|
IP
|
$4,844.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
76101864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$629.79 |
| Max. Negotiated Rate |
$4,650.74 |
| Rate for Payer: Aetna Commercial |
$3,730.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.73
|
| Rate for Payer: Cash Price |
$2,422.26
|
| Rate for Payer: Cigna Commercial |
$4,020.95
|
| Rate for Payer: First Health Commercial |
$4,602.29
|
| Rate for Payer: Humana Commercial |
$4,117.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.80
|
| Rate for Payer: PHCS Commercial |
$4,650.74
|
| Rate for Payer: United Healthcare All Payer |
$4,263.18
|
|
|
EXCHANGE JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$4,844.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
76101864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$629.79 |
| Max. Negotiated Rate |
$4,650.74 |
| Rate for Payer: Aetna Commercial |
$3,730.28
|
| Rate for Payer: Anthem Medicaid |
$1,666.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$2,422.26
|
| Rate for Payer: Cash Price |
$2,422.26
|
| Rate for Payer: Cigna Commercial |
$4,020.95
|
| Rate for Payer: First Health Commercial |
$4,602.29
|
| Rate for Payer: Humana Commercial |
$4,117.84
|
| Rate for Payer: Humana KY Medicaid |
$1,666.03
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,699.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.80
|
| Rate for Payer: PHCS Commercial |
$4,650.74
|
| Rate for Payer: United Healthcare All Payer |
$4,263.18
|
|
|
EXCHANGE JEJUNOSTOMY TUBE
|
Professional
|
Both
|
$4,844.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
76101864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,844.52 |
| Rate for Payer: Buckeye Medicare Advantage |
$4,844.52
|
| Rate for Payer: Cash Price |
$2,422.26
|
| Rate for Payer: Cash Price |
$2,422.26
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,906.71
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,391.16
|
| Rate for Payer: UHCCP Medicaid |
$1,695.58
|
|
|
EXCHANGE JEJUNOSTOMY TUBE(P
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
761P1864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,150.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$2,150.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Cash Price |
$1,075.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,505.00
|
| Rate for Payer: UHCCP Medicaid |
$752.50
|
|
|
EXCHANGE JEJUNOSTOMY TUBE(T
|
Facility
|
OP
|
$2,694.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
761T1864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.29 |
| Max. Negotiated Rate |
$2,586.74 |
| Rate for Payer: Aetna Commercial |
$2,074.78
|
| Rate for Payer: Anthem Medicaid |
$926.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,101.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Cash Price |
$1,347.26
|
| Rate for Payer: Cash Price |
$1,347.26
|
| Rate for Payer: Cigna Commercial |
$2,236.45
|
| Rate for Payer: First Health Commercial |
$2,559.79
|
| Rate for Payer: Humana Commercial |
$2,290.34
|
| Rate for Payer: Humana KY Medicaid |
$926.65
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Kentucky WC Medicaid |
$936.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,371.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,020.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$350.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$835.30
|
| Rate for Payer: PHCS Commercial |
$2,586.74
|
| Rate for Payer: United Healthcare All Payer |
$2,371.18
|
|
|
EXCHANGE JEJUNOSTOMY TUBE(T
|
Facility
|
IP
|
$2,694.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
761T1864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.29 |
| Max. Negotiated Rate |
$2,586.74 |
| Rate for Payer: Aetna Commercial |
$2,074.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,101.73
|
| Rate for Payer: Cash Price |
$1,347.26
|
| Rate for Payer: Cigna Commercial |
$2,236.45
|
| Rate for Payer: First Health Commercial |
$2,559.79
|
| Rate for Payer: Humana Commercial |
$2,290.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,209.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,988.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,371.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,020.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$538.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$350.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$835.30
|
| Rate for Payer: PHCS Commercial |
$2,586.74
|
| Rate for Payer: United Healthcare All Payer |
$2,371.18
|
|
|
EXCHANGE NEPHROSTOMY CATH
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
76102051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.81 |
| Max. Negotiated Rate |
$2,723.52 |
| Rate for Payer: Aetna Commercial |
$2,184.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,212.86
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$2,354.71
|
| Rate for Payer: First Health Commercial |
$2,695.15
|
| Rate for Payer: Humana Commercial |
$2,411.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,326.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,093.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$851.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,496.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,127.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.47
|
| Rate for Payer: PHCS Commercial |
$2,723.52
|
| Rate for Payer: United Healthcare All Payer |
$2,496.56
|
|
|
EXCHANGE NEPHROSTOMY CATH
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
76102051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$368.81 |
| Max. Negotiated Rate |
$2,723.52 |
| Rate for Payer: Aetna Commercial |
$2,184.49
|
| Rate for Payer: Anthem Medicaid |
$975.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,212.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$2,354.71
|
| Rate for Payer: First Health Commercial |
$2,695.15
|
| Rate for Payer: Humana Commercial |
$2,411.45
|
| Rate for Payer: Humana KY Medicaid |
$975.64
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$985.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,326.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,093.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$995.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,496.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,127.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$567.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$368.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.47
|
| Rate for Payer: PHCS Commercial |
$2,723.52
|
| Rate for Payer: United Healthcare All Payer |
$2,496.56
|
|
|
EXCHANGE NEPHROSTOMY CATH
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
76102051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$2,837.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.72
|
| Rate for Payer: Anthem Medicaid |
$82.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,837.00
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cash Price |
$1,418.50
|
| Rate for Payer: Cigna Commercial |
$169.00
|
| Rate for Payer: Humana Medicaid |
$82.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.00
|
| Rate for Payer: Molina Healthcare Passport |
$82.35
|
| Rate for Payer: Multiplan PHCS |
$1,702.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,985.90
|
| Rate for Payer: UHCCP Medicaid |
$85.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.17
|
|
|
EXCHANGE NEPHROSTOMY CATH(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
761P2051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.72
|
| Rate for Payer: Anthem Medicaid |
$82.35
|
| 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 |
$169.00
|
| Rate for Payer: Humana Medicaid |
$82.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.00
|
| Rate for Payer: Molina Healthcare Passport |
$82.35
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$85.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$83.17
|
|
|
EXCHANGE NEPHROSTOMY CATH(T
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
761T2051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.81 |
| Max. Negotiated Rate |
$2,465.88 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,761.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,465.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,377.81
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cash Price |
$1,268.50
|
| Rate for Payer: Cigna Commercial |
$2,105.71
|
| Rate for Payer: First Health Commercial |
$2,410.15
|
| Rate for Payer: Humana Commercial |
$2,156.45
|
| Rate for Payer: Humana KY Medicaid |
$872.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,761.34
|
| Rate for Payer: Kentucky WC Medicaid |
$881.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,080.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,872.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,113.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$889.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,232.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,902.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$786.47
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
