|
EXPLORATION OF HIP JOINT
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
76100764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,123.20 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
EXPLORATION OF HIP JOINT
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
76100764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$402.36 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$900.90
|
| Rate for Payer: Anthem Medicaid |
$402.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$912.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$971.10
|
| Rate for Payer: First Health Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial |
$994.50
|
| Rate for Payer: Humana KY Medicaid |
$402.36
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$406.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$959.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$863.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,029.60
|
| Rate for Payer: Ohio Health Group HMO |
$877.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$936.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$807.30
|
| Rate for Payer: PHCS Commercial |
$1,123.20
|
| Rate for Payer: United Healthcare All Payer |
$1,029.60
|
|
|
EXPLORATION OF HIP JOINT
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
76100764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,584.80 |
| Rate for Payer: Aetna Commercial |
$1,457.83
|
| Rate for Payer: Ambetter Exchange |
$925.62
|
| Rate for Payer: Anthem Medicaid |
$717.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$925.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.74
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,584.80
|
| Rate for Payer: Healthspan PPO |
$1,320.49
|
| Rate for Payer: Humana Medicaid |
$717.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,217.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$925.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.55
|
| Rate for Payer: Molina Healthcare Passport |
$717.21
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,203.31
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$925.62
|
|
|
EXPLORATION OF HIP JOINT(P
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
HCPCS 27033
|
| Hospital Charge Code |
761P0764
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$1,584.80 |
| Rate for Payer: Aetna Commercial |
$1,457.83
|
| Rate for Payer: Ambetter Exchange |
$925.62
|
| Rate for Payer: Anthem Medicaid |
$717.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$925.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$925.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,110.74
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,584.80
|
| Rate for Payer: Healthspan PPO |
$1,320.49
|
| Rate for Payer: Humana Medicaid |
$717.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,217.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$925.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$731.55
|
| Rate for Payer: Molina Healthcare Passport |
$717.21
|
| Rate for Payer: Multiplan PHCS |
$702.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,203.31
|
| Rate for Payer: UHCCP Medicaid |
$409.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$724.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$925.62
|
|
|
EXPLORATION OF KNEE JOINT
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
76100811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
EXPLORATION OF KNEE JOINT
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
76100811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| 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 |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
EXPLORATION OF KNEE JOINT
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
76100811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.56 |
| Max. Negotiated Rate |
$1,157.77 |
| Rate for Payer: Aetna Commercial |
$1,067.09
|
| Rate for Payer: Ambetter Exchange |
$699.19
|
| Rate for Payer: Anthem Medicaid |
$536.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$699.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$699.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$839.03
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,157.77
|
| Rate for Payer: Healthspan PPO |
$966.56
|
| Rate for Payer: Humana Medicaid |
$536.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$903.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$699.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$699.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$547.29
|
| Rate for Payer: Molina Healthcare Passport |
$536.56
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$908.95
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$541.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$699.19
|
|
|
EXPLORATION OF KNEE JOINT(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 27310
|
| Hospital Charge Code |
761P0811
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$536.56 |
| Max. Negotiated Rate |
$1,157.77 |
| Rate for Payer: Aetna Commercial |
$1,067.09
|
| Rate for Payer: Ambetter Exchange |
$699.19
|
| Rate for Payer: Anthem Medicaid |
$536.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$699.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$699.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$839.03
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,157.77
|
| Rate for Payer: Healthspan PPO |
$966.56
|
| Rate for Payer: Humana Medicaid |
$536.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$903.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$699.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$699.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$547.29
|
| Rate for Payer: Molina Healthcare Passport |
$536.56
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$908.95
|
| Rate for Payer: UHCCP Medicaid |
$595.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$541.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$699.19
|
|
|
EXPLORATION OF MIDDLE EAR
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
76102422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$522.73 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem Medicaid |
$522.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Humana KY Medicaid |
$522.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$528.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
EXPLORATION OF MIDDLE EAR
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
76102422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
EXPLORATION OF MIDDLE EAR
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
76102422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.18 |
| Max. Negotiated Rate |
$967.17 |
| Rate for Payer: Aetna Commercial |
$967.17
|
| Rate for Payer: Ambetter Exchange |
$636.89
|
| Rate for Payer: Anthem Medicaid |
$470.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$636.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$636.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.27
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$941.58
|
| Rate for Payer: Healthspan PPO |
$857.92
|
| Rate for Payer: Humana Medicaid |
$470.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$874.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.58
|
| Rate for Payer: Molina Healthcare Passport |
$470.18
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$827.96
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$636.89
|
|
|
EXPLORATION OF MIDDLE EAR(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 69440
|
| Hospital Charge Code |
761P2422
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.18 |
| Max. Negotiated Rate |
$967.17 |
| Rate for Payer: Aetna Commercial |
$967.17
|
| Rate for Payer: Ambetter Exchange |
$636.89
|
| Rate for Payer: Anthem Medicaid |
$470.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$636.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$636.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.27
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$941.58
|
| Rate for Payer: Healthspan PPO |
$857.92
|
| Rate for Payer: Humana Medicaid |
$470.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$874.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$636.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$479.58
|
| Rate for Payer: Molina Healthcare Passport |
$470.18
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$827.96
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$474.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$636.89
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); CHEST
|
Facility
|
OP
|
$2,366.24
|
|
|
Service Code
|
CPT 20101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$2,366.24 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
|
|
EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 20103
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
EXPLORATION - REM. FOREIGN BO
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76100595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.01 |
| Max. Negotiated Rate |
$859.01 |
| Rate for Payer: Aetna Commercial |
$629.22
|
| Rate for Payer: Ambetter Exchange |
$399.68
|
| Rate for Payer: Anthem Medicaid |
$213.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$399.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$399.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$479.62
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$859.01
|
| Rate for Payer: Healthspan PPO |
$569.94
|
| Rate for Payer: Humana Medicaid |
$213.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$527.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$399.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.27
|
| Rate for Payer: Molina Healthcare Passport |
$213.01
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$519.58
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$399.68
|
|
|
EXPLORATION - REM. FOREIGN BO
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76100595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXPLORATION - REM. FOREIGN BO
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
76100595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EXPLORATION - REM. FOREIGN B(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 25248
|
| Hospital Charge Code |
761P0595
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.01 |
| Max. Negotiated Rate |
$859.01 |
| Rate for Payer: Aetna Commercial |
$629.22
|
| Rate for Payer: Ambetter Exchange |
$399.68
|
| Rate for Payer: Anthem Medicaid |
$213.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$399.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$399.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$479.62
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$859.01
|
| Rate for Payer: Healthspan PPO |
$569.94
|
| Rate for Payer: Humana Medicaid |
$213.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$527.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$399.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.27
|
| Rate for Payer: Molina Healthcare Passport |
$213.01
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$519.58
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$399.68
|
|
|
EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR WRIST
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 25248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
EXPLORATORY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
76101974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$479.94 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,115.90
|
| Rate for Payer: Ambetter Exchange |
$733.12
|
| Rate for Payer: Anthem Medicaid |
$479.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$733.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$733.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$879.74
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,040.70
|
| Rate for Payer: Healthspan PPO |
$941.06
|
| Rate for Payer: Humana Medicaid |
$479.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$982.14
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$733.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$733.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$489.54
|
| Rate for Payer: Molina Healthcare Passport |
$479.94
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$953.06
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$484.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$733.12
|
|
|
EXPLORATORY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
76101974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLORATORY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 49000
|
| Hospital Charge Code |
76101974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
EXPLORATORY HEART SURGERY
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
76101283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.50 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,675.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.75
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
EXPLORATORY HEART SURGERY
|
Professional
|
Both
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
76101283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$851.81 |
| Max. Negotiated Rate |
$1,980.20 |
| Rate for Payer: Aetna Commercial |
$1,980.20
|
| Rate for Payer: Ambetter Exchange |
$1,097.96
|
| Rate for Payer: Anthem Medicaid |
$851.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,097.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,097.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,317.55
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$1,889.69
|
| Rate for Payer: Healthspan PPO |
$1,946.92
|
| Rate for Payer: Humana Medicaid |
$851.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,620.92
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,097.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,097.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$868.85
|
| Rate for Payer: Molina Healthcare Passport |
$851.81
|
| Rate for Payer: Multiplan PHCS |
$1,845.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,427.35
|
| Rate for Payer: UHCCP Medicaid |
$1,076.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$860.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,097.96
|
|
|
EXPLORATORY HEART SURGERY
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS 33310
|
| Hospital Charge Code |
76101283
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$922.50 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,675.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.75
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
