|
INCISION OF BURN SCAB
|
Facility
|
OP
|
$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 Medicaid |
$761.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$1,107.23
|
| 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: Humana KY Medicaid |
$761.55
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$769.30
|
| 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 |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$776.83
|
| 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
|
|
|
INCISION OF BURN SCAB(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
761P0246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$321.44
|
| Rate for Payer: Anthem Medicaid |
$191.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| 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 |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.53
|
|
|
INCISION OF BURN SCAB(T
|
Facility
|
IP
|
$1,564.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
761T0246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$1,501.88 |
| Rate for Payer: Aetna Commercial |
$1,204.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.28
|
| Rate for Payer: Cash Price |
$782.23
|
| Rate for Payer: Cigna Commercial |
$1,298.50
|
| Rate for Payer: First Health Commercial |
$1,486.24
|
| Rate for Payer: Humana Commercial |
$1,329.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.98
|
| Rate for Payer: PHCS Commercial |
$1,501.88
|
| Rate for Payer: United Healthcare All Payer |
$1,376.72
|
|
|
INCISION OF BURN SCAB(T
|
Facility
|
OP
|
$1,564.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
761T0246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.38 |
| Max. Negotiated Rate |
$1,501.88 |
| Rate for Payer: Aetna Commercial |
$1,204.63
|
| Rate for Payer: Anthem Medicaid |
$538.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$782.23
|
| Rate for Payer: Cash Price |
$782.23
|
| Rate for Payer: Cigna Commercial |
$1,298.50
|
| Rate for Payer: First Health Commercial |
$1,486.24
|
| Rate for Payer: Humana Commercial |
$1,329.79
|
| Rate for Payer: Humana KY Medicaid |
$538.02
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$543.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.98
|
| Rate for Payer: PHCS Commercial |
$1,501.88
|
| Rate for Payer: United Healthcare All Payer |
$1,376.72
|
|
|
INCISION OF COLLARBONE JOIN(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
761P0443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Anthem Medicaid |
$309.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$762.96
|
| Rate for Payer: Healthspan PPO |
$625.37
|
| Rate for Payer: Humana Medicaid |
$309.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$598.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.19
|
| Rate for Payer: Molina Healthcare Passport |
$309.99
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.09
|
|
|
INCISION OF COLLARBONE JOINT
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| 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 |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Humana KY Medicaid |
$292.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$295.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
INCISION OF COLLARBONE JOINT
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Anthem Medicaid |
$309.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$762.96
|
| Rate for Payer: Healthspan PPO |
$625.37
|
| Rate for Payer: Humana Medicaid |
$309.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$598.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$316.19
|
| Rate for Payer: Molina Healthcare Passport |
$309.99
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.09
|
|
|
INCISION OF COLLARBONE JOINT
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$705.50
|
| Rate for Payer: First Health Commercial |
$807.50
|
| Rate for Payer: Humana Commercial |
$722.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$627.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.00
|
| Rate for Payer: Ohio Health Group HMO |
$637.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$110.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$263.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
INCISION OF FOOT TENDON
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
76100996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
INCISION OF FOOT TENDON
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
76100996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
INCISION OF FOOT TENDON
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
76100996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$396.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.66
|
| Rate for Payer: Anthem Medicaid |
$117.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$438.83
|
| Rate for Payer: Healthspan PPO |
$489.39
|
| Rate for Payer: Humana Medicaid |
$117.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$327.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.88
|
| Rate for Payer: Molina Healthcare Passport |
$117.53
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$142.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.71
|
|
|
INCISION OF FOOT TENDON(P
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
761P0996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$117.53 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$396.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.66
|
| Rate for Payer: Anthem Medicaid |
$117.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$438.83
|
| Rate for Payer: Healthspan PPO |
$489.39
|
| Rate for Payer: Humana Medicaid |
$117.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$327.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.88
|
| Rate for Payer: Molina Healthcare Passport |
$117.53
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$142.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.71
|
|
|
INCISION OF FOOT TENDON(S)
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
76100994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$448.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.14
|
| Rate for Payer: Anthem Medicaid |
$155.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$536.56
|
| Rate for Payer: Humana Medicaid |
$155.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.42
|
| Rate for Payer: Molina Healthcare Passport |
$155.31
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$151.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.86
|
|
|
INCISION OF FOOT TENDON(S)
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
76100994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$825.60 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.60
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
INCISION OF FOOT TENDON(S)
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
76100994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Humana KY Medicaid |
$295.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$298.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.60
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
INCISION OF FOOT TENDON(S)(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
761P0994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$448.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.14
|
| Rate for Payer: Anthem Medicaid |
$155.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$860.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$536.56
|
| Rate for Payer: Humana Medicaid |
$155.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$158.42
|
| Rate for Payer: Molina Healthcare Passport |
$155.31
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$602.00
|
| Rate for Payer: UHCCP Medicaid |
$151.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$156.86
|
|
|
INCISION OF GALLBLADDER
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
76101954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.95 |
| Max. Negotiated Rate |
$2,126.40 |
| Rate for Payer: Aetna Commercial |
$1,705.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.70
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,838.45
|
| Rate for Payer: First Health Commercial |
$2,104.25
|
| Rate for Payer: Humana Commercial |
$1,882.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,816.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,949.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,661.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.65
|
| Rate for Payer: PHCS Commercial |
$2,126.40
|
| Rate for Payer: United Healthcare All Payer |
$1,949.20
|
|
|
INCISION OF GALLBLADDER
|
Facility
|
OP
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
76101954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$287.95 |
| Max. Negotiated Rate |
$2,126.40 |
| Rate for Payer: Aetna Commercial |
$1,705.55
|
| Rate for Payer: Anthem Medicaid |
$761.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.70
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,838.45
|
| Rate for Payer: First Health Commercial |
$2,104.25
|
| Rate for Payer: Humana Commercial |
$1,882.75
|
| Rate for Payer: Humana KY Medicaid |
$761.74
|
| Rate for Payer: Kentucky WC Medicaid |
$769.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,816.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$777.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,949.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,661.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.65
|
| Rate for Payer: PHCS Commercial |
$2,126.40
|
| Rate for Payer: United Healthcare All Payer |
$1,949.20
|
|
|
INCISION OF GALLBLADDER
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
76101954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.70 |
| Max. Negotiated Rate |
$2,215.00 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Anthem Medicaid |
$478.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,215.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,112.96
|
| Rate for Payer: Healthspan PPO |
$1,022.34
|
| Rate for Payer: Humana Medicaid |
$478.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,095.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.27
|
| Rate for Payer: Molina Healthcare Passport |
$478.70
|
| Rate for Payer: Multiplan PHCS |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,550.50
|
| Rate for Payer: UHCCP Medicaid |
$775.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.49
|
|
|
INCISION OF GALLBLADDER(P
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
761P1954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.70 |
| Max. Negotiated Rate |
$2,215.00 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Anthem Medicaid |
$478.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,215.00
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,112.96
|
| Rate for Payer: Healthspan PPO |
$1,022.34
|
| Rate for Payer: Humana Medicaid |
$478.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,095.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.27
|
| Rate for Payer: Molina Healthcare Passport |
$478.70
|
| Rate for Payer: Multiplan PHCS |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,550.50
|
| Rate for Payer: UHCCP Medicaid |
$775.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.49
|
|
|
INCISION OF HEART SAC
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
76101238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.02 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,458.13
|
| Rate for Payer: Anthem Medicaid |
$742.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,371.08
|
| Rate for Payer: Healthspan PPO |
$1,433.63
|
| Rate for Payer: Humana Medicaid |
$742.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,218.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$756.86
|
| Rate for Payer: Molina Healthcare Passport |
$742.02
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$749.44
|
|
|
INCISION OF HEART SAC
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
76101238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
INCISION OF HEART SAC
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
76101238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$682.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
INCISION OF HEART SAC(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
761P1238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.02 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: Aetna Commercial |
$1,458.13
|
| Rate for Payer: Anthem Medicaid |
$742.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,200.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,371.08
|
| Rate for Payer: Healthspan PPO |
$1,433.63
|
| Rate for Payer: Humana Medicaid |
$742.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,218.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$756.86
|
| Rate for Payer: Molina Healthcare Passport |
$742.02
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,540.00
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$749.44
|
|
|
INCISION OF HEEL BONE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
76101005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Aetna Commercial |
$1,005.86
|
| Rate for Payer: Anthem Medicaid |
$461.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$850.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cash Price |
$425.00
|
| Rate for Payer: Cigna Commercial |
$1,099.80
|
| Rate for Payer: Healthspan PPO |
$911.09
|
| Rate for Payer: Humana Medicaid |
$461.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$827.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$470.92
|
| Rate for Payer: Molina Healthcare Passport |
$461.69
|
| Rate for Payer: Multiplan PHCS |
$510.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$595.00
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.31
|
|
