|
INCISION OF HEEL BONE
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
76101005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| 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 |
$6,186.50
|
| 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 |
$7,423.80
|
| 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 HEEL BONE
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
76101005
|
|
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 HEEL BONE(P
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
761P1005
|
|
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
|
|
|
INCISION OF HIP TENDONS
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
76100761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna Commercial |
$1,086.27
|
| Rate for Payer: Anthem Medicaid |
$421.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$1,188.90
|
| Rate for Payer: Healthspan PPO |
$983.93
|
| Rate for Payer: Humana Medicaid |
$421.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$913.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$430.37
|
| Rate for Payer: Molina Healthcare Passport |
$421.93
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.15
|
|
|
INCISION OF HIP TENDONS
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
76100761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$883.20 |
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.20
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
INCISION OF HIP TENDONS
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
76100761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem Medicaid |
$316.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| 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 |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Humana KY Medicaid |
$316.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$319.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$322.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$285.20
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
INCISION OF HIP TENDONS(P
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
761P0761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.00 |
| Max. Negotiated Rate |
$1,188.90 |
| Rate for Payer: Aetna Commercial |
$1,086.27
|
| Rate for Payer: Anthem Medicaid |
$421.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$920.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$1,188.90
|
| Rate for Payer: Healthspan PPO |
$983.93
|
| Rate for Payer: Humana Medicaid |
$421.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$913.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$430.37
|
| Rate for Payer: Molina Healthcare Passport |
$421.93
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$644.00
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.15
|
|
|
INCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$2,781.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
76101647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.53 |
| Max. Negotiated Rate |
$2,669.76 |
| Rate for Payer: Aetna Commercial |
$2,141.37
|
| Rate for Payer: Anthem Medicaid |
$956.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,169.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cigna Commercial |
$2,308.23
|
| Rate for Payer: First Health Commercial |
$2,641.95
|
| Rate for Payer: Humana Commercial |
$2,363.85
|
| Rate for Payer: Humana KY Medicaid |
$956.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$966.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,280.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,052.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$975.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,447.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,085.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.11
|
| Rate for Payer: PHCS Commercial |
$2,669.76
|
| Rate for Payer: United Healthcare All Payer |
$2,447.28
|
|
|
INCISION OF LINGUAL FRENUM
|
Professional
|
Both
|
$2,781.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
76101647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$2,781.00 |
| Rate for Payer: Aetna Commercial |
$151.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.10
|
| Rate for Payer: Anthem Medicaid |
$45.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,781.00
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cigna Commercial |
$255.78
|
| Rate for Payer: Healthspan PPO |
$226.95
|
| Rate for Payer: Humana Medicaid |
$45.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.73
|
| Rate for Payer: Molina Healthcare Passport |
$45.81
|
| Rate for Payer: Multiplan PHCS |
$1,668.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,946.70
|
| Rate for Payer: UHCCP Medicaid |
$62.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.27
|
|
|
INCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$2,781.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
76101647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.53 |
| Max. Negotiated Rate |
$2,669.76 |
| Rate for Payer: Aetna Commercial |
$2,141.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,169.18
|
| Rate for Payer: Cash Price |
$1,390.50
|
| Rate for Payer: Cigna Commercial |
$2,308.23
|
| Rate for Payer: First Health Commercial |
$2,641.95
|
| Rate for Payer: Humana Commercial |
$2,363.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,280.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,052.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,447.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,085.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.11
|
| Rate for Payer: PHCS Commercial |
$2,669.76
|
| Rate for Payer: United Healthcare All Payer |
$2,447.28
|
|
|
INCISION OF LINGUAL FRENUM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
761P1647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$255.78 |
| Rate for Payer: Aetna Commercial |
$151.90
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$59.10
|
| Rate for Payer: Anthem Medicaid |
$45.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$255.78
|
| Rate for Payer: Healthspan PPO |
$226.95
|
| Rate for Payer: Humana Medicaid |
$45.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.73
|
| Rate for Payer: Molina Healthcare Passport |
$45.81
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$62.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.27
|
|
|
INCISION OF LINGUAL FRENUM(T
|
Facility
|
IP
|
$2,531.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
761T1647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$2,429.76 |
| Rate for Payer: Aetna Commercial |
$1,948.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.18
|
| Rate for Payer: Cash Price |
$1,265.50
|
| Rate for Payer: Cigna Commercial |
$2,100.73
|
| Rate for Payer: First Health Commercial |
$2,404.45
|
| Rate for Payer: Humana Commercial |
$2,151.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$759.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.61
|
| Rate for Payer: PHCS Commercial |
$2,429.76
|
| Rate for Payer: United Healthcare All Payer |
$2,227.28
|
|
|
INCISION OF LINGUAL FRENUM(T
|
Facility
|
OP
|
$2,531.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
761T1647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.03 |
| Max. Negotiated Rate |
$2,429.76 |
| Rate for Payer: Aetna Commercial |
$1,948.87
|
| Rate for Payer: Anthem Medicaid |
$870.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,974.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,265.50
|
| Rate for Payer: Cash Price |
$1,265.50
|
| Rate for Payer: Cigna Commercial |
$2,100.73
|
| Rate for Payer: First Health Commercial |
$2,404.45
|
| Rate for Payer: Humana Commercial |
$2,151.35
|
| Rate for Payer: Humana KY Medicaid |
$870.41
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$879.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,075.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,867.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$887.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,227.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,898.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$329.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.61
|
| Rate for Payer: PHCS Commercial |
$2,429.76
|
| Rate for Payer: United Healthcare All Payer |
$2,227.28
|
|
|
INCISION OF LIP FOLD
|
Facility
|
IP
|
$933.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
76101633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.29 |
| Max. Negotiated Rate |
$895.68 |
| Rate for Payer: Aetna Commercial |
$718.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$727.74
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$774.39
|
| Rate for Payer: First Health Commercial |
$886.35
|
| Rate for Payer: Humana Commercial |
$793.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$688.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.04
|
| Rate for Payer: Ohio Health Group HMO |
$699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.23
|
| Rate for Payer: PHCS Commercial |
$895.68
|
| Rate for Payer: United Healthcare All Payer |
$821.04
|
|
|
INCISION OF LIP FOLD
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
76101633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$933.00 |
| Rate for Payer: Aetna Commercial |
$48.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.12
|
| Rate for Payer: Anthem Medicaid |
$19.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$933.00
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$130.75
|
| Rate for Payer: Healthspan PPO |
$119.04
|
| Rate for Payer: Humana Medicaid |
$19.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.87
|
| Rate for Payer: Molina Healthcare Passport |
$19.48
|
| Rate for Payer: Multiplan PHCS |
$559.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$653.10
|
| Rate for Payer: UHCCP Medicaid |
$22.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.67
|
|
|
INCISION OF LIP FOLD
|
Facility
|
OP
|
$933.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
76101633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$121.29 |
| Max. Negotiated Rate |
$895.68 |
| Rate for Payer: Aetna Commercial |
$718.41
|
| Rate for Payer: Anthem Medicaid |
$320.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$727.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$774.39
|
| Rate for Payer: First Health Commercial |
$886.35
|
| Rate for Payer: Humana Commercial |
$793.05
|
| Rate for Payer: Humana KY Medicaid |
$320.86
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$324.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$688.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$327.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.04
|
| Rate for Payer: Ohio Health Group HMO |
$699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$289.23
|
| Rate for Payer: PHCS Commercial |
$895.68
|
| Rate for Payer: United Healthcare All Payer |
$821.04
|
|
|
INCISION OF LIP FOLD(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
761P1633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$48.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.12
|
| Rate for Payer: Anthem Medicaid |
$19.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$130.75
|
| Rate for Payer: Healthspan PPO |
$119.04
|
| Rate for Payer: Humana Medicaid |
$19.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.87
|
| Rate for Payer: Molina Healthcare Passport |
$19.48
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$22.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.67
|
|
|
INCISION OF LIP FOLD(T
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
761T1633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$666.11 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$475.79
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INCISION OF LIP FOLD(T
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
761T1633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.29 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.23
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INCISION OF METATARSAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
76101007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.25
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
INCISION OF METATARSAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
76101007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| 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 |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$199.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.25
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
INCISION OF METATARSAL
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
76101007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$678.34 |
| Rate for Payer: Aetna Commercial |
$562.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$196.22
|
| Rate for Payer: Anthem Medicaid |
$314.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$599.04
|
| Rate for Payer: Healthspan PPO |
$678.34
|
| Rate for Payer: Humana Medicaid |
$314.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare Passport |
$314.66
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$206.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.81
|
|
|
INCISION OF METATARSAL(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
761P1007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$678.34 |
| Rate for Payer: Aetna Commercial |
$562.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$196.22
|
| Rate for Payer: Anthem Medicaid |
$314.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$575.00
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$599.04
|
| Rate for Payer: Healthspan PPO |
$678.34
|
| Rate for Payer: Humana Medicaid |
$314.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare Passport |
$314.66
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$402.50
|
| Rate for Payer: UHCCP Medicaid |
$206.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.81
|
|
|
INCISION OF SPINAL NERVE
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
76102367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.35 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$194.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$463.45
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
INCISION OF SPINAL NERVE
|
Professional
|
Both
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
76102367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.42 |
| Max. Negotiated Rate |
$1,495.00 |
| Rate for Payer: Aetna Commercial |
$903.55
|
| Rate for Payer: Anthem Medicaid |
$412.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,495.00
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$801.01
|
| Rate for Payer: Healthspan PPO |
$705.47
|
| Rate for Payer: Humana Medicaid |
$412.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$734.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.67
|
| Rate for Payer: Molina Healthcare Passport |
$412.42
|
| Rate for Payer: Multiplan PHCS |
$897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,046.50
|
| Rate for Payer: UHCCP Medicaid |
$523.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.54
|
|
