|
INC/DRAIN INTRAORAL APPROACH
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
76101697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
INC/DRAIN INTRAORAL APPROACH
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
76101697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
INC/DRAIN INTRAORAL APPROACH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
76101697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$581.34 |
| Rate for Payer: Aetna Commercial |
$581.34
|
| Rate for Payer: Ambetter Exchange |
$365.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.31
|
| Rate for Payer: Anthem Medicaid |
$132.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$365.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.02
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$571.66
|
| Rate for Payer: Healthspan PPO |
$552.53
|
| Rate for Payer: Humana Medicaid |
$132.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.28
|
| Rate for Payer: Molina Healthcare Passport |
$132.63
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$474.53
|
| Rate for Payer: UHCCP Medicaid |
$236.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$365.02
|
|
|
INC/DRAIN INTRAORAL APPROACH(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 42720
|
| Hospital Charge Code |
761P1697
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$581.34 |
| Rate for Payer: Aetna Commercial |
$581.34
|
| Rate for Payer: Ambetter Exchange |
$365.02
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.31
|
| Rate for Payer: Anthem Medicaid |
$132.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$365.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$365.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$438.02
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$571.66
|
| Rate for Payer: Healthspan PPO |
$552.53
|
| Rate for Payer: Humana Medicaid |
$132.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$511.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.28
|
| Rate for Payer: Molina Healthcare Passport |
$132.63
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$474.53
|
| Rate for Payer: UHCCP Medicaid |
$236.58
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$365.02
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.20 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem Medicaid |
$634.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Humana KY Medicaid |
$634.15
|
| Rate for Payer: Kentucky WC Medicaid |
$640.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.36
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.21 |
| Max. Negotiated Rate |
$1,106.40 |
| Rate for Payer: Aetna Commercial |
$668.50
|
| Rate for Payer: Ambetter Exchange |
$428.73
|
| Rate for Payer: Anthem Medicaid |
$262.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$428.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$428.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$514.48
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$753.46
|
| Rate for Payer: Healthspan PPO |
$605.52
|
| Rate for Payer: Humana Medicaid |
$262.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$590.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$428.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$428.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.45
|
| Rate for Payer: Molina Healthcare Passport |
$262.21
|
| Rate for Payer: Multiplan PHCS |
$1,106.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$557.35
|
| Rate for Payer: UHCCP Medicaid |
$645.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$428.73
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$553.20 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.36
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.20 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.36
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCIS DP W/OPENBONECORTEXTHORA
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
HCPCS 21510
|
| Hospital Charge Code |
76100391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$553.20 |
| Max. Negotiated Rate |
$1,770.24 |
| Rate for Payer: Aetna Commercial |
$1,419.88
|
| Rate for Payer: Anthem Medicaid |
$634.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,438.32
|
| Rate for Payer: Cash Price |
$922.00
|
| Rate for Payer: Cigna Commercial |
$1,530.52
|
| Rate for Payer: First Health Commercial |
$1,751.80
|
| Rate for Payer: Humana Commercial |
$1,567.40
|
| Rate for Payer: Humana KY Medicaid |
$634.15
|
| Rate for Payer: Kentucky WC Medicaid |
$640.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,512.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,360.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,622.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,475.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,604.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.36
|
| Rate for Payer: PHCS Commercial |
$1,770.24
|
| Rate for Payer: United Healthcare All Payer |
$1,622.72
|
|
|
INCISE BLADDER/DRAIN URETER
|
Facility
|
OP
|
$6,570.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
76102060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.78 |
| Max. Negotiated Rate |
$6,308.04 |
| Rate for Payer: Aetna Commercial |
$5,059.58
|
| Rate for Payer: Anthem Medicaid |
$2,259.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,125.29
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cigna Commercial |
$5,453.83
|
| Rate for Payer: First Health Commercial |
$6,242.34
|
| Rate for Payer: Humana Commercial |
$5,585.25
|
| Rate for Payer: Humana KY Medicaid |
$2,259.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,282.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,388.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,849.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,305.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,782.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,928.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,256.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,716.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,533.91
|
| Rate for Payer: PHCS Commercial |
$6,308.04
|
| Rate for Payer: United Healthcare All Payer |
$5,782.37
|
|
|
INCISE BLADDER/DRAIN URETER
|
Facility
|
IP
|
$6,570.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
76102060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,971.26 |
| Max. Negotiated Rate |
$6,308.04 |
| Rate for Payer: Aetna Commercial |
$5,059.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,125.29
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cigna Commercial |
$5,453.83
|
| Rate for Payer: First Health Commercial |
$6,242.34
|
| Rate for Payer: Humana Commercial |
$5,585.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,388.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,849.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,971.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,782.37
|
| Rate for Payer: Ohio Health Group HMO |
$4,928.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,256.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,716.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,533.91
|
| Rate for Payer: PHCS Commercial |
$6,308.04
|
| Rate for Payer: United Healthcare All Payer |
$5,782.37
|
|
|
INCISE BLADDER/DRAIN URETER
|
Professional
|
Both
|
$6,570.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
76102060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$3,942.53 |
| Rate for Payer: Aetna Commercial |
$749.07
|
| Rate for Payer: Ambetter Exchange |
$465.03
|
| Rate for Payer: Anthem Medicaid |
$322.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$465.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$465.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$558.04
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cash Price |
$3,285.44
|
| Rate for Payer: Cigna Commercial |
$672.34
|
| Rate for Payer: Healthspan PPO |
$598.95
|
| Rate for Payer: Humana Medicaid |
$322.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$660.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$465.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.87
|
| Rate for Payer: Molina Healthcare Passport |
$322.42
|
| Rate for Payer: Multiplan PHCS |
$3,942.53
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$604.54
|
| Rate for Payer: UHCCP Medicaid |
$2,299.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$465.03
|
|
|
INCISE BLADDER/DRAIN URETER(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
761P2060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$749.07
|
| Rate for Payer: Ambetter Exchange |
$465.03
|
| Rate for Payer: Anthem Medicaid |
$322.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$465.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$465.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$558.04
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$672.34
|
| Rate for Payer: Healthspan PPO |
$598.95
|
| Rate for Payer: Humana Medicaid |
$322.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$660.28
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$465.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.87
|
| Rate for Payer: Molina Healthcare Passport |
$322.42
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$604.54
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$465.03
|
|
|
INCISE BLADDER/DRAIN URETER(T
|
Facility
|
IP
|
$5,045.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
761T2060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,513.76 |
| Max. Negotiated Rate |
$4,844.04 |
| Rate for Payer: Aetna Commercial |
$3,885.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.79
|
| Rate for Payer: Cash Price |
$2,522.94
|
| Rate for Payer: Cigna Commercial |
$4,188.08
|
| Rate for Payer: First Health Commercial |
$4,793.59
|
| Rate for Payer: Humana Commercial |
$4,289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,137.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,440.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,784.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.66
|
| Rate for Payer: PHCS Commercial |
$4,844.04
|
| Rate for Payer: United Healthcare All Payer |
$4,440.37
|
|
|
INCISE BLADDER/DRAIN URETER(T
|
Facility
|
OP
|
$5,045.88
|
|
|
Service Code
|
HCPCS 51045
|
| Hospital Charge Code |
761T2060
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,735.28 |
| Max. Negotiated Rate |
$4,844.04 |
| Rate for Payer: Aetna Commercial |
$3,885.33
|
| Rate for Payer: Anthem Medicaid |
$1,735.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.79
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$2,522.94
|
| Rate for Payer: Cash Price |
$2,522.94
|
| Rate for Payer: Cigna Commercial |
$4,188.08
|
| Rate for Payer: First Health Commercial |
$4,793.59
|
| Rate for Payer: Humana Commercial |
$4,289.00
|
| Rate for Payer: Humana KY Medicaid |
$1,735.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,137.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,770.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,440.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,784.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.66
|
| Rate for Payer: PHCS Commercial |
$4,844.04
|
| Rate for Payer: United Healthcare All Payer |
$4,440.37
|
|
|
INCISE FINGER TENDON SHEATH
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
76100660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$682.96 |
| Rate for Payer: Aetna Commercial |
$410.93
|
| Rate for Payer: Ambetter Exchange |
$279.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.37
|
| Rate for Payer: Anthem Medicaid |
$176.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.38
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$452.11
|
| Rate for Payer: Healthspan PPO |
$682.96
|
| Rate for Payer: Humana Medicaid |
$176.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$367.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.23
|
| Rate for Payer: Molina Healthcare Passport |
$176.70
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.32
|
| Rate for Payer: UHCCP Medicaid |
$157.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.48
|
|
|
INCISE FINGER TENDON SHEATH
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
76100660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
INCISE FINGER TENDON SHEATH
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
76100660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.11 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| 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 |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$321.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
INCISE FINGER TENDON SHEATH(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 26055
|
| Hospital Charge Code |
761P0660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.37 |
| Max. Negotiated Rate |
$682.96 |
| Rate for Payer: Aetna Commercial |
$410.93
|
| Rate for Payer: Ambetter Exchange |
$279.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$150.37
|
| Rate for Payer: Anthem Medicaid |
$176.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$279.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$279.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$335.38
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$452.11
|
| Rate for Payer: Healthspan PPO |
$682.96
|
| Rate for Payer: Humana Medicaid |
$176.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$367.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$279.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.23
|
| Rate for Payer: Molina Healthcare Passport |
$176.70
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$363.32
|
| Rate for Payer: UHCCP Medicaid |
$157.89
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$279.48
|
|
|
INCISE HAND/FINGER TENDON
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 26460
|
| Hospital Charge Code |
76100703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| 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 |
$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 |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| 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 |
$1,774.50
|
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INCISE HAND/FINGER TENDON
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 26460
|
| Hospital Charge Code |
76100703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$247.50 |
| 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 |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
INCISE HAND/FINGER TENDON
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 26460
|
| Hospital Charge Code |
76100703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.14 |
| Max. Negotiated Rate |
$657.51 |
| Rate for Payer: Aetna Commercial |
$541.99
|
| Rate for Payer: Ambetter Exchange |
$417.46
|
| Rate for Payer: Anthem Medicaid |
$151.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$417.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$500.95
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$657.51
|
| Rate for Payer: Healthspan PPO |
$490.93
|
| Rate for Payer: Humana Medicaid |
$151.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$417.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.16
|
| Rate for Payer: Molina Healthcare Passport |
$151.14
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.70
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$152.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$417.46
|
|
|
INCISE HAND/FINGER TENDON(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 26460
|
| Hospital Charge Code |
761P0703
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.14 |
| Max. Negotiated Rate |
$657.51 |
| Rate for Payer: Aetna Commercial |
$541.99
|
| Rate for Payer: Ambetter Exchange |
$417.46
|
| Rate for Payer: Anthem Medicaid |
$151.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$417.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$500.95
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$657.51
|
| Rate for Payer: Healthspan PPO |
$490.93
|
| Rate for Payer: Humana Medicaid |
$151.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$470.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$417.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$417.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$154.16
|
| Rate for Payer: Molina Healthcare Passport |
$151.14
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.70
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$152.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$417.46
|
|
|
INCISE THIGH TENDON & FASCIA
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 27305
|
| Hospital Charge Code |
76100810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
|
INCISE THIGH TENDON & FASCIA
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 27305
|
| Hospital Charge Code |
76100810
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| 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 |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
