|
INCISION BONE CORTEX FOOT
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 28005
|
| Hospital Charge Code |
76100966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Aetna Commercial |
$922.92
|
| Rate for Payer: Anthem Medicaid |
$348.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$1,001.30
|
| Rate for Payer: Healthspan PPO |
$835.97
|
| Rate for Payer: Humana Medicaid |
$348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$739.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$355.70
|
| Rate for Payer: Molina Healthcare Passport |
$348.73
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.22
|
|
|
INCISION BONE CORTEX FOOT
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS 28005
|
| Hospital Charge Code |
76100966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
INCISION BONE CORTEX FOOT
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS 28005
|
| Hospital Charge Code |
76100966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
INCISION BONE CORTEX FOOT(P
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 28005
|
| Hospital Charge Code |
761P0966
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$1,001.30 |
| Rate for Payer: Aetna Commercial |
$922.92
|
| Rate for Payer: Anthem Medicaid |
$348.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$1,001.30
|
| Rate for Payer: Healthspan PPO |
$835.97
|
| Rate for Payer: Humana Medicaid |
$348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$739.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$355.70
|
| Rate for Payer: Molina Healthcare Passport |
$348.73
|
| Rate for Payer: Multiplan PHCS |
$468.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$546.00
|
| Rate for Payer: UHCCP Medicaid |
$273.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$352.22
|
|
|
INCISION BX EYELID SKIN INCLID
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
76102390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$128.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.93
|
| Rate for Payer: Anthem Medicaid |
$55.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,056.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$274.38
|
| Rate for Payer: Healthspan PPO |
$258.57
|
| Rate for Payer: Humana Medicaid |
$55.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.62
|
| Rate for Payer: Molina Healthcare Passport |
$55.51
|
| Rate for Payer: Multiplan PHCS |
$633.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.20
|
| Rate for Payer: UHCCP Medicaid |
$56.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.07
|
|
|
INCISION BX EYELID SKIN INCLID
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
761T2390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$754.56 |
| Rate for Payer: Aetna Commercial |
$605.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.08
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$652.38
|
| Rate for Payer: First Health Commercial |
$746.70
|
| Rate for Payer: Humana Commercial |
$668.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.68
|
| Rate for Payer: Ohio Health Group HMO |
$589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.66
|
| Rate for Payer: PHCS Commercial |
$754.56
|
| Rate for Payer: United Healthcare All Payer |
$691.68
|
|
|
INCISION BX EYELID SKIN INCLID
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
761P2390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$274.38 |
| Rate for Payer: Aetna Commercial |
$128.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.93
|
| Rate for Payer: Anthem Medicaid |
$55.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$274.38
|
| Rate for Payer: Healthspan PPO |
$258.57
|
| Rate for Payer: Humana Medicaid |
$55.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$56.62
|
| Rate for Payer: Molina Healthcare Passport |
$55.51
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$56.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.07
|
|
|
INCISION BX EYELID SKIN INCLID
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
76102390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$1,013.76 |
| Rate for Payer: Aetna Commercial |
$813.12
|
| Rate for Payer: Anthem Medicaid |
$363.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$823.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$876.48
|
| Rate for Payer: First Health Commercial |
$1,003.20
|
| Rate for Payer: Humana Commercial |
$897.60
|
| Rate for Payer: Humana KY Medicaid |
$363.16
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$366.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$779.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$929.28
|
| Rate for Payer: Ohio Health Group HMO |
$792.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.36
|
| Rate for Payer: PHCS Commercial |
$1,013.76
|
| Rate for Payer: United Healthcare All Payer |
$929.28
|
|
|
INCISION BX EYELID SKIN INCLID
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
761T2390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.18 |
| Max. Negotiated Rate |
$754.56 |
| Rate for Payer: Aetna Commercial |
$605.22
|
| Rate for Payer: Anthem Medicaid |
$270.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$251.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$613.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$352.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$340.08
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cash Price |
$393.00
|
| Rate for Payer: Cigna Commercial |
$652.38
|
| Rate for Payer: First Health Commercial |
$746.70
|
| Rate for Payer: Humana Commercial |
$668.10
|
| Rate for Payer: Humana KY Medicaid |
$270.31
|
| Rate for Payer: Humana Medicare Advantage |
$251.91
|
| Rate for Payer: Kentucky WC Medicaid |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$644.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$580.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$691.68
|
| Rate for Payer: Ohio Health Group HMO |
$589.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$157.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.66
|
| Rate for Payer: PHCS Commercial |
$754.56
|
| Rate for Payer: United Healthcare All Payer |
$691.68
|
|
|
INCISION BX EYELID SKIN INCLID
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
76102390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$1,013.76 |
| Rate for Payer: First Health Commercial |
$1,003.20
|
| Rate for Payer: Aetna Commercial |
$813.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$823.68
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$876.48
|
| Rate for Payer: Humana Commercial |
$897.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$865.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$779.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$316.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$929.28
|
| Rate for Payer: Ohio Health Group HMO |
$792.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$211.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$137.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$327.36
|
| Rate for Payer: PHCS Commercial |
$1,013.76
|
| Rate for Payer: United Healthcare All Payer |
$929.28
|
|
|
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 25000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
INCISION/FIXATION OF FEMUR
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
76102604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.90
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
INCISION/FIXATION OF FEMUR
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
76102604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,190.54 |
| Rate for Payer: Aetna Commercial |
$2,036.11
|
| Rate for Payer: Anthem Medicaid |
$988.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,590.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,190.54
|
| Rate for Payer: Healthspan PPO |
$1,844.28
|
| Rate for Payer: Humana Medicaid |
$988.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,719.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,008.59
|
| Rate for Payer: Molina Healthcare Passport |
$988.81
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,113.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$998.70
|
|
|
INCISION/FIXATION OF FEMUR
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
76102604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.70 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem Medicaid |
$546.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Humana KY Medicaid |
$546.80
|
| Rate for Payer: Kentucky WC Medicaid |
$552.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.90
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
INCISION/FIXATION OF FEMUR
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
761P2604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,190.54 |
| Rate for Payer: Aetna Commercial |
$2,036.11
|
| Rate for Payer: Anthem Medicaid |
$988.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,590.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,190.54
|
| Rate for Payer: Healthspan PPO |
$1,844.28
|
| Rate for Payer: Humana Medicaid |
$988.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,719.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,008.59
|
| Rate for Payer: Molina Healthcare Passport |
$988.81
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,113.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$998.70
|
|
|
INCISION LEG OR ANKLE
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
76100889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.55
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INCISION LEG OR ANKLE
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
76100889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.55
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INCISION LEG OR ANKLE
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
76100889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$973.51 |
| Rate for Payer: Aetna Commercial |
$904.57
|
| Rate for Payer: Anthem Medicaid |
$391.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$805.00
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$973.51
|
| Rate for Payer: Healthspan PPO |
$819.35
|
| Rate for Payer: Humana Medicaid |
$391.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.72
|
| Rate for Payer: Molina Healthcare Passport |
$391.88
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$563.50
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.80
|
|
|
INCISION LEG OR ANKLE(P
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
761P0889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$973.51 |
| Rate for Payer: Aetna Commercial |
$904.57
|
| Rate for Payer: Anthem Medicaid |
$391.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$805.00
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$973.51
|
| Rate for Payer: Healthspan PPO |
$819.35
|
| Rate for Payer: Humana Medicaid |
$391.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.72
|
| Rate for Payer: Molina Healthcare Passport |
$391.88
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$563.50
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.80
|
|
|
INCISION OF ACHILLES TENDON
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
76100888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$441.22
|
| Rate for Payer: Anthem Medicaid |
$178.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$491.99
|
| Rate for Payer: Healthspan PPO |
$399.65
|
| Rate for Payer: Humana Medicaid |
$178.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$360.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.51
|
| Rate for Payer: Molina Healthcare Passport |
$178.93
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.72
|
|
|
INCISION OF ACHILLES TENDON
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
76100888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INCISION OF ACHILLES TENDON
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
76100888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$286.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$107.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.75
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INCISION OF ACHILLES TENDON(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
761P0888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Aetna Commercial |
$441.22
|
| Rate for Payer: Anthem Medicaid |
$178.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$825.00
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$491.99
|
| Rate for Payer: Healthspan PPO |
$399.65
|
| Rate for Payer: Humana Medicaid |
$178.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$360.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.51
|
| Rate for Payer: Molina Healthcare Passport |
$178.93
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$577.50
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.72
|
|
|
INCISION OF BURN SCAB
|
Professional
|
Both
|
$2,214.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
76100246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$2,214.46 |
| Rate for Payer: Aetna Commercial |
$321.44
|
| Rate for Payer: Anthem Medicaid |
$191.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,214.46
|
| Rate for Payer: Cash Price |
$1,107.23
|
| Rate for Payer: Cash Price |
$1,107.23
|
| Rate for Payer: Cigna Commercial |
$307.71
|
| Rate for Payer: Healthspan PPO |
$257.02
|
| Rate for Payer: Humana Medicaid |
$191.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.44
|
| Rate for Payer: Molina Healthcare Passport |
$191.61
|
| Rate for Payer: Multiplan PHCS |
$1,328.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,550.12
|
| Rate for Payer: UHCCP Medicaid |
$775.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.53
|
|
|
INCISION OF BURN SCAB
|
Facility
|
IP
|
$2,214.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
76100246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.88 |
| Max. Negotiated Rate |
$2,125.88 |
| Rate for Payer: Aetna Commercial |
$1,705.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.28
|
| Rate for Payer: Cash Price |
$1,107.23
|
| Rate for Payer: Cigna Commercial |
$1,838.00
|
| Rate for Payer: First Health Commercial |
$2,103.74
|
| Rate for Payer: Humana Commercial |
$1,882.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,815.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,948.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,660.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.48
|
| Rate for Payer: PHCS Commercial |
$2,125.88
|
| Rate for Payer: United Healthcare All Payer |
$1,948.72
|
|
