|
INCISION BX EYELID SKIN INCLID
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
76102390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$128.26
|
| Rate for Payer: Ambetter Exchange |
$63.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.93
|
| Rate for Payer: Anthem Medicaid |
$66.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.78
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$274.38
|
| Rate for Payer: Healthspan PPO |
$258.57
|
| Rate for Payer: Humana Medicaid |
$66.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.70
|
| Rate for Payer: Molina Healthcare Passport |
$66.37
|
| Rate for Payer: Multiplan PHCS |
$633.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.17
|
| Rate for Payer: UHCCP Medicaid |
$56.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.98
|
|
|
INCISION BX EYELID SKIN INCLID
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 67810
|
| Hospital Charge Code |
761P2390
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$53.93 |
| Max. Negotiated Rate |
$274.38 |
| Rate for Payer: Aetna Commercial |
$128.26
|
| Rate for Payer: Ambetter Exchange |
$63.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$53.93
|
| Rate for Payer: Anthem Medicaid |
$66.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.78
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$274.38
|
| Rate for Payer: Healthspan PPO |
$258.57
|
| Rate for Payer: Humana Medicaid |
$66.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$67.70
|
| Rate for Payer: Molina Healthcare Passport |
$66.37
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$83.17
|
| Rate for Payer: UHCCP Medicaid |
$56.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.98
|
|
|
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 25000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
INCISION/FIXATION OF FEMUR
|
Facility
|
OP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
76102604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem Medicaid |
$546.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Humana KY Medicaid |
$546.80
|
| Rate for Payer: Kentucky WC Medicaid |
$552.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$557.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.10
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
INCISION/FIXATION OF FEMUR
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
761P2604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,190.54 |
| Rate for Payer: Aetna Commercial |
$2,036.11
|
| Rate for Payer: Ambetter Exchange |
$1,299.23
|
| Rate for Payer: Anthem Medicaid |
$988.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,299.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,299.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,559.08
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,190.54
|
| Rate for Payer: Healthspan PPO |
$1,844.28
|
| Rate for Payer: Humana Medicaid |
$988.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,719.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,299.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,008.59
|
| Rate for Payer: Molina Healthcare Passport |
$988.81
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,689.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$998.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,299.23
|
|
|
INCISION/FIXATION OF FEMUR
|
Facility
|
IP
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
76102604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$477.00 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna Commercial |
$1,224.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,240.20
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$1,319.70
|
| Rate for Payer: First Health Commercial |
$1,510.50
|
| Rate for Payer: Humana Commercial |
$1,351.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,303.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,173.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$477.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,399.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,192.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,383.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.10
|
| Rate for Payer: PHCS Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare All Payer |
$1,399.20
|
|
|
INCISION/FIXATION OF FEMUR
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 27165
|
| Hospital Charge Code |
76102604
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$2,190.54 |
| Rate for Payer: Aetna Commercial |
$2,036.11
|
| Rate for Payer: Ambetter Exchange |
$1,299.23
|
| Rate for Payer: Anthem Medicaid |
$988.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,299.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,299.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,559.08
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cash Price |
$795.00
|
| Rate for Payer: Cigna Commercial |
$2,190.54
|
| Rate for Payer: Healthspan PPO |
$1,844.28
|
| Rate for Payer: Humana Medicaid |
$988.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,719.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,299.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,008.59
|
| Rate for Payer: Molina Healthcare Passport |
$988.81
|
| Rate for Payer: Multiplan PHCS |
$954.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,689.00
|
| Rate for Payer: UHCCP Medicaid |
$556.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$998.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,299.23
|
|
|
INCISION LEG OR ANKLE
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
76100889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.84 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| 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 |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INCISION LEG OR ANKLE
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
76100889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$973.51 |
| Rate for Payer: Aetna Commercial |
$904.57
|
| Rate for Payer: Ambetter Exchange |
$568.76
|
| Rate for Payer: Anthem Medicaid |
$391.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$682.51
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$973.51
|
| Rate for Payer: Healthspan PPO |
$819.35
|
| Rate for Payer: Humana Medicaid |
$391.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.72
|
| Rate for Payer: Molina Healthcare Passport |
$391.88
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.39
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.76
|
|
|
INCISION LEG OR ANKLE
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
76100889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
INCISION LEG OR ANKLE(P
|
Professional
|
Both
|
$805.00
|
|
|
Service Code
|
HCPCS 27607
|
| Hospital Charge Code |
761P0889
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$973.51 |
| Rate for Payer: Aetna Commercial |
$904.57
|
| Rate for Payer: Ambetter Exchange |
$568.76
|
| Rate for Payer: Anthem Medicaid |
$391.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$682.51
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$973.51
|
| Rate for Payer: Healthspan PPO |
$819.35
|
| Rate for Payer: Humana Medicaid |
$391.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$399.72
|
| Rate for Payer: Molina Healthcare Passport |
$391.88
|
| Rate for Payer: Multiplan PHCS |
$483.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.39
|
| Rate for Payer: UHCCP Medicaid |
$281.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$395.80
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.76
|
|
|
INCISION OF ACHILLES TENDON
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
76100888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| 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 |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| 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 |
$3,597.54
|
| 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
|
|
|
INCISION OF ACHILLES TENDON
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
76100888
|
|
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
|
|
|
INCISION OF ACHILLES TENDON
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
76100888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$441.22
|
| Rate for Payer: Ambetter Exchange |
$257.92
|
| Rate for Payer: Anthem Medicaid |
$178.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$257.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$257.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$491.99
|
| Rate for Payer: Healthspan PPO |
$399.65
|
| Rate for Payer: Humana Medicaid |
$178.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$360.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$257.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.51
|
| Rate for Payer: Molina Healthcare Passport |
$178.93
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.30
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.92
|
|
|
INCISION OF ACHILLES TENDON(P
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 27606
|
| Hospital Charge Code |
761P0888
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.93 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$441.22
|
| Rate for Payer: Ambetter Exchange |
$257.92
|
| Rate for Payer: Anthem Medicaid |
$178.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$257.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$257.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$309.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$491.99
|
| Rate for Payer: Healthspan PPO |
$399.65
|
| Rate for Payer: Humana Medicaid |
$178.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$360.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$257.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.51
|
| Rate for Payer: Molina Healthcare Passport |
$178.93
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$335.30
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$257.92
|
|
|
INCISION OF BURN SCAB
|
Facility
|
IP
|
$2,214.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
76100246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.34 |
| Max. Negotiated Rate |
$2,125.88 |
| Rate for Payer: Aetna Commercial |
$1,705.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.28
|
| Rate for Payer: Cash Price |
$1,107.23
|
| Rate for Payer: Cigna Commercial |
$1,838.00
|
| Rate for Payer: First Health Commercial |
$2,103.74
|
| Rate for Payer: Humana Commercial |
$1,882.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,815.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,948.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,660.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,771.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,926.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,527.98
|
| Rate for Payer: PHCS Commercial |
$2,125.88
|
| Rate for Payer: United Healthcare All Payer |
$1,948.72
|
|
|
INCISION OF BURN SCAB
|
Professional
|
Both
|
$2,214.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
76100246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.44 |
| Max. Negotiated Rate |
$1,328.68 |
| Rate for Payer: Aetna Commercial |
$321.44
|
| Rate for Payer: Ambetter Exchange |
$185.44
|
| Rate for Payer: Anthem Medicaid |
$191.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.53
|
| Rate for Payer: Cash Price |
$1,107.23
|
| Rate for Payer: Cash Price |
$1,107.23
|
| Rate for Payer: Cigna Commercial |
$307.71
|
| Rate for Payer: Healthspan PPO |
$257.02
|
| Rate for Payer: Humana Medicaid |
$191.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$257.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$185.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$195.44
|
| Rate for Payer: Molina Healthcare Passport |
$191.61
|
| Rate for Payer: Multiplan PHCS |
$1,328.68
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$241.07
|
| Rate for Payer: UHCCP Medicaid |
$775.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.44
|
|
|
INCISION OF BURN SCAB
|
Facility
|
OP
|
$2,214.46
|
|
|
Service Code
|
HCPCS 16035
|
| Hospital Charge Code |
76100246
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.16 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$1,660.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,771.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,926.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,527.98
|
| 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 |
$185.44 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Commercial |
$321.44
|
| Rate for Payer: Ambetter Exchange |
$185.44
|
| Rate for Payer: Anthem Medicaid |
$191.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$185.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$185.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.53
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$185.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.44
|
| 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 |
$241.07
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$193.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$185.44
|
|
|
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 |
$369.16 |
| 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 |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| 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 |
$369.16
|
| 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 |
$442.99
|
| 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 |
$1,173.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,361.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.48
|
| Rate for Payer: PHCS Commercial |
$1,501.88
|
| Rate for Payer: United Healthcare All Payer |
$1,376.72
|
|
|
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 |
$469.34 |
| 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 |
$1,173.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,361.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.48
|
| 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 |
$762.96 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Ambetter Exchange |
$481.14
|
| Rate for Payer: Anthem Medicaid |
$309.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$481.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.14
|
| 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 |
$625.48
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.14
|
|
|
INCISION OF COLLARBONE JOINT
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$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 |
$292.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| Rate for Payer: PHCS Commercial |
$816.00
|
| Rate for Payer: United Healthcare All Payer |
$748.00
|
|
|
INCISION OF COLLARBONE JOINT
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 23106
|
| Hospital Charge Code |
76100443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$255.00 |
| 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 |
$680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$739.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$586.50
|
| 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 |
$762.96 |
| Rate for Payer: Aetna Commercial |
$690.42
|
| Rate for Payer: Ambetter Exchange |
$481.14
|
| Rate for Payer: Anthem Medicaid |
$309.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$481.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$481.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.14
|
| 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 |
$625.48
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$313.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.14
|
|
