|
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 |
$754.90 |
| Rate for Payer: Aetna Commercial |
$680.16
|
| Rate for Payer: Ambetter Exchange |
$503.23
|
| Rate for Payer: Anthem Medicaid |
$266.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$603.88
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$503.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.23
|
| 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 |
$654.20
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.23
|
|
|
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 |
$944.92 |
| Rate for Payer: Aetna Commercial |
$826.28
|
| Rate for Payer: Ambetter Exchange |
$524.11
|
| Rate for Payer: Anthem Medicaid |
$390.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$524.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$628.93
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$524.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.11
|
| 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 |
$681.34
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.11
|
|
|
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 |
$620.68 |
| Rate for Payer: Ambetter Exchange |
$122.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.94
|
| Rate for Payer: Anthem Medicaid |
$608.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.54
|
| 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 |
$608.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$620.68
|
| Rate for Payer: Molina Healthcare Passport |
$608.51
|
| Rate for Payer: Multiplan PHCS |
$415.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.84
|
| Rate for Payer: UHCCP Medicaid |
$125.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$614.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.95
|
|
|
EXCHANGE JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$4,844.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
76101864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| 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 |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| 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 |
$866.29
|
| 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 |
$1,039.55
|
| 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 |
$3,875.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.72
|
| Rate for Payer: PHCS Commercial |
$4,650.74
|
| Rate for Payer: United Healthcare All Payer |
$4,263.18
|
|
|
EXCHANGE JEJUNOSTOMY TUBE
|
Facility
|
IP
|
$4,844.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
76101864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,453.36 |
| 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 |
$3,875.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.72
|
| 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 |
$3,391.16 |
| 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 |
$1,505.00 |
| 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
|
IP
|
$2,694.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
761T1864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.36 |
| 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 |
$2,155.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,859.22
|
| Rate for Payer: PHCS Commercial |
$2,586.74
|
| Rate for Payer: United Healthcare All Payer |
$2,371.18
|
|
|
EXCHANGE JEJUNOSTOMY TUBE(T
|
Facility
|
OP
|
$2,694.52
|
|
|
Service Code
|
HCPCS 44799
|
| Hospital Charge Code |
761T1864
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| 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 |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,101.73
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| 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 |
$866.29
|
| 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 |
$1,039.55
|
| 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 |
$2,155.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,344.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,859.22
|
| Rate for Payer: PHCS Commercial |
$2,586.74
|
| Rate for Payer: United Healthcare All Payer |
$2,371.18
|
|
|
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 |
$1,702.20 |
| Rate for Payer: Ambetter Exchange |
$92.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.72
|
| Rate for Payer: Anthem Medicaid |
$352.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.10
|
| 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 |
$352.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.04
|
| Rate for Payer: Molina Healthcare Passport |
$352.98
|
| Rate for Payer: Multiplan PHCS |
$1,702.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.35
|
| Rate for Payer: UHCCP Medicaid |
$85.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.58
|
|
|
EXCHANGE NEPHROSTOMY CATH
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
76102051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.10 |
| 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 |
$2,269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,468.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,957.53
|
| 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 |
$975.64 |
| 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 |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,212.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$2,269.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,468.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,957.53
|
| Rate for Payer: PHCS Commercial |
$2,723.52
|
| Rate for Payer: United Healthcare All Payer |
$2,496.56
|
|
|
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 |
$360.04 |
| Rate for Payer: Ambetter Exchange |
$92.58
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$81.72
|
| Rate for Payer: Anthem Medicaid |
$352.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$92.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$92.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$111.10
|
| 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 |
$352.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$137.97
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$92.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.04
|
| Rate for Payer: Molina Healthcare Passport |
$352.98
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$120.35
|
| Rate for Payer: UHCCP Medicaid |
$85.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.51
|
| Rate for Payer: Wellcare Medicare Advantage |
$92.58
|
|
|
EXCHANGE NEPHROSTOMY CATH(T
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
761T2051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$761.10 |
| Max. Negotiated Rate |
$2,435.52 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| 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: 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 |
$761.10
|
| 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 |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
EXCHANGE NEPHROSTOMY CATH(T
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
HCPCS 50435
|
| Hospital Charge Code |
761T2051
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.47 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$1,953.49
|
| Rate for Payer: Anthem Medicaid |
$872.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,978.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| 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 |
$1,892.78
|
| 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 |
$2,271.34
|
| 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 |
$2,029.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,207.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.53
|
| Rate for Payer: PHCS Commercial |
$2,435.52
|
| Rate for Payer: United Healthcare All Payer |
$2,232.56
|
|
|
EXCHANGE OF BILIARY DRAIN CATH
|
Facility
|
OP
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
76101960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.98 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$532.84
|
| Rate for Payer: Anthem Medicaid |
$237.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$539.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna Commercial |
$574.36
|
| Rate for Payer: First Health Commercial |
$657.40
|
| Rate for Payer: Humana Commercial |
$588.20
|
| Rate for Payer: Humana KY Medicaid |
$237.98
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$240.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$567.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$510.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$608.96
|
| Rate for Payer: Ohio Health Group HMO |
$519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.48
|
| Rate for Payer: PHCS Commercial |
$664.32
|
| Rate for Payer: United Healthcare All Payer |
$608.96
|
|
|
EXCHANGE OF BILIARY DRAIN CATH
|
Facility
|
IP
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
76101960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.60 |
| Max. Negotiated Rate |
$664.32 |
| Rate for Payer: Aetna Commercial |
$532.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$539.76
|
| Rate for Payer: Cash Price |
$346.00
|
| Rate for Payer: Cigna Commercial |
$574.36
|
| Rate for Payer: First Health Commercial |
$657.40
|
| Rate for Payer: Humana Commercial |
$588.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$567.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$510.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$608.96
|
| Rate for Payer: Ohio Health Group HMO |
$519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.48
|
| Rate for Payer: PHCS Commercial |
$664.32
|
| Rate for Payer: United Healthcare All Payer |
$608.96
|
|
|
EXCHANGE OF BILIARY DRAIN CATH
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 47536
|
| Hospital Charge Code |
76101960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$620.68 |
| Rate for Payer: Ambetter Exchange |
$122.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.94
|
| Rate for Payer: Anthem Medicaid |
$608.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.54
|
| 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 |
$608.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$208.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$620.68
|
| Rate for Payer: Molina Healthcare Passport |
$608.51
|
| Rate for Payer: Multiplan PHCS |
$415.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.84
|
| Rate for Payer: UHCCP Medicaid |
$125.94
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$614.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.95
|
|
|
EXCHANGE OF HIP HARDWARE
|
Facility
|
IP
|
$7,831.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76100882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,349.41 |
| Max. Negotiated Rate |
$7,518.10 |
| Rate for Payer: Aetna Commercial |
$6,030.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,108.45
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cigna Commercial |
$6,500.02
|
| Rate for Payer: First Health Commercial |
$7,439.78
|
| Rate for Payer: Humana Commercial |
$6,656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,421.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,779.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,349.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,891.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,873.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,265.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,813.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.63
|
| Rate for Payer: PHCS Commercial |
$7,518.10
|
| Rate for Payer: United Healthcare All Payer |
$6,891.59
|
|
|
EXCHANGE OF HIP HARDWARE
|
Professional
|
Both
|
$7,831.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76100882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$5,481.94 |
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$4,698.81
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,481.94
|
| Rate for Payer: UHCCP Medicaid |
$2,740.97
|
|
|
EXCHANGE OF HIP HARDWARE
|
Facility
|
OP
|
$7,831.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
76100882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$7,518.10 |
| Rate for Payer: Aetna Commercial |
$6,030.14
|
| Rate for Payer: Anthem Medicaid |
$2,693.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,108.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cash Price |
$3,915.68
|
| Rate for Payer: Cigna Commercial |
$6,500.02
|
| Rate for Payer: First Health Commercial |
$7,439.78
|
| Rate for Payer: Humana Commercial |
$6,656.65
|
| Rate for Payer: Humana KY Medicaid |
$2,693.20
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,720.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,421.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,779.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,747.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,891.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,873.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,265.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,813.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,403.63
|
| Rate for Payer: PHCS Commercial |
$7,518.10
|
| Rate for Payer: United Healthcare All Payer |
$6,891.59
|
|
|
EXCHANGE OF HIP HARDWARE(P
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
761P0882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,505.00 |
| 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 OF HIP HARDWARE(T
|
Facility
|
OP
|
$5,681.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
761T0882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$5,454.10 |
| Rate for Payer: Aetna Commercial |
$4,374.64
|
| Rate for Payer: Anthem Medicaid |
$1,953.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,431.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$2,840.68
|
| Rate for Payer: Cash Price |
$2,840.68
|
| Rate for Payer: Cigna Commercial |
$4,715.52
|
| Rate for Payer: First Health Commercial |
$5,397.28
|
| Rate for Payer: Humana Commercial |
$4,829.15
|
| Rate for Payer: Humana KY Medicaid |
$1,953.82
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,973.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,658.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,192.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,993.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,999.59
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,545.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,942.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.13
|
| Rate for Payer: PHCS Commercial |
$5,454.10
|
| Rate for Payer: United Healthcare All Payer |
$4,999.59
|
|
|
EXCHANGE OF HIP HARDWARE(T
|
Facility
|
IP
|
$5,681.35
|
|
|
Service Code
|
HCPCS 27599
|
| Hospital Charge Code |
761T0882
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$5,454.10 |
| Rate for Payer: Aetna Commercial |
$4,374.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,431.45
|
| Rate for Payer: Cash Price |
$2,840.68
|
| Rate for Payer: Cigna Commercial |
$4,715.52
|
| Rate for Payer: First Health Commercial |
$5,397.28
|
| Rate for Payer: Humana Commercial |
$4,829.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,658.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,192.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,704.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,999.59
|
| Rate for Payer: Ohio Health Group HMO |
$4,261.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,545.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,942.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,920.13
|
| Rate for Payer: PHCS Commercial |
$5,454.10
|
| Rate for Payer: United Healthcare All Payer |
$4,999.59
|
|
|
EXC HDRDNTS INGU SMPL/INT RP(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 11462
|
| Hospital Charge Code |
761P0071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$131.15 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$317.67
|
| Rate for Payer: Ambetter Exchange |
$237.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.15
|
| Rate for Payer: Anthem Medicaid |
$142.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$237.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$237.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$285.42
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$290.86
|
| Rate for Payer: Healthspan PPO |
$376.40
|
| Rate for Payer: Humana Medicaid |
$142.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$288.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$237.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.49
|
| Rate for Payer: Molina Healthcare Passport |
$142.64
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.20
|
| Rate for Payer: UHCCP Medicaid |
$137.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$237.85
|
|
