|
INCISION OF FOOT TENDON
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
76100996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| 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 |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
INCISION OF FOOT TENDON
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
76100996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.66 |
| Max. Negotiated Rate |
$489.39 |
| Rate for Payer: Aetna Commercial |
$396.31
|
| Rate for Payer: Ambetter Exchange |
$256.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.66
|
| Rate for Payer: Anthem Medicaid |
$138.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$256.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$256.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$307.43
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$438.83
|
| Rate for Payer: Healthspan PPO |
$489.39
|
| Rate for Payer: Humana Medicaid |
$138.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$256.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.81
|
| Rate for Payer: Molina Healthcare Passport |
$138.05
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$333.05
|
| Rate for Payer: UHCCP Medicaid |
$142.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.19
|
|
|
INCISION OF FOOT TENDON
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
76100996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
INCISION OF FOOT TENDON(P
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 28234
|
| Hospital Charge Code |
761P0996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$135.66 |
| Max. Negotiated Rate |
$489.39 |
| Rate for Payer: Aetna Commercial |
$396.31
|
| Rate for Payer: Ambetter Exchange |
$256.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$135.66
|
| Rate for Payer: Anthem Medicaid |
$138.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$256.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$256.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$307.43
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$438.83
|
| Rate for Payer: Healthspan PPO |
$489.39
|
| Rate for Payer: Humana Medicaid |
$138.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$327.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$256.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.81
|
| Rate for Payer: Molina Healthcare Passport |
$138.05
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$333.05
|
| Rate for Payer: UHCCP Medicaid |
$142.44
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$256.19
|
|
|
INCISION OF FOOT TENDON(S)
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
76100994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$536.56 |
| Rate for Payer: Aetna Commercial |
$448.93
|
| Rate for Payer: Ambetter Exchange |
$271.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.14
|
| Rate for Payer: Anthem Medicaid |
$187.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$271.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$271.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$325.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$536.56
|
| Rate for Payer: Humana Medicaid |
$187.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$271.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$191.66
|
| Rate for Payer: Molina Healthcare Passport |
$187.90
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$352.95
|
| Rate for Payer: UHCCP Medicaid |
$151.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$271.50
|
|
|
INCISION OF FOOT TENDON(S)
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
76100994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$825.60 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
INCISION OF FOOT TENDON(S)
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
76100994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$662.20
|
| Rate for Payer: Anthem Medicaid |
$295.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$670.80
|
| 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 |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$713.80
|
| Rate for Payer: First Health Commercial |
$817.00
|
| Rate for Payer: Humana Commercial |
$731.00
|
| Rate for Payer: Humana KY Medicaid |
$295.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$298.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$705.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$634.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$301.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$756.80
|
| Rate for Payer: Ohio Health Group HMO |
$645.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$748.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$593.40
|
| Rate for Payer: PHCS Commercial |
$825.60
|
| Rate for Payer: United Healthcare All Payer |
$756.80
|
|
|
INCISION OF FOOT TENDON(S)(P
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 28230
|
| Hospital Charge Code |
761P0994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$536.56 |
| Rate for Payer: Aetna Commercial |
$448.93
|
| Rate for Payer: Ambetter Exchange |
$271.50
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$144.14
|
| Rate for Payer: Anthem Medicaid |
$187.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$271.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$271.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$325.80
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cash Price |
$430.00
|
| Rate for Payer: Cigna Commercial |
$509.73
|
| Rate for Payer: Healthspan PPO |
$536.56
|
| Rate for Payer: Humana Medicaid |
$187.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$353.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$271.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$191.66
|
| Rate for Payer: Molina Healthcare Passport |
$187.90
|
| Rate for Payer: Multiplan PHCS |
$516.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$352.95
|
| Rate for Payer: UHCCP Medicaid |
$151.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$189.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$271.50
|
|
|
INCISION OF GALLBLADDER
|
Facility
|
IP
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
76101954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.50 |
| Max. Negotiated Rate |
$2,126.40 |
| Rate for Payer: Aetna Commercial |
$1,705.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.70
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,838.45
|
| Rate for Payer: First Health Commercial |
$2,104.25
|
| Rate for Payer: Humana Commercial |
$1,882.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,816.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,949.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,661.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,927.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.35
|
| Rate for Payer: PHCS Commercial |
$2,126.40
|
| Rate for Payer: United Healthcare All Payer |
$1,949.20
|
|
|
INCISION OF GALLBLADDER
|
Facility
|
OP
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
76101954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$664.50 |
| Max. Negotiated Rate |
$2,126.40 |
| Rate for Payer: Aetna Commercial |
$1,705.55
|
| Rate for Payer: Anthem Medicaid |
$761.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.70
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,838.45
|
| Rate for Payer: First Health Commercial |
$2,104.25
|
| Rate for Payer: Humana Commercial |
$1,882.75
|
| Rate for Payer: Humana KY Medicaid |
$761.74
|
| Rate for Payer: Kentucky WC Medicaid |
$769.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,816.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$777.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,949.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,661.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,927.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.35
|
| Rate for Payer: PHCS Commercial |
$2,126.40
|
| Rate for Payer: United Healthcare All Payer |
$1,949.20
|
|
|
INCISION OF GALLBLADDER
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
76101954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.70 |
| Max. Negotiated Rate |
$1,329.00 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Ambetter Exchange |
$834.95
|
| Rate for Payer: Anthem Medicaid |
$478.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$834.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$834.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,001.94
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,112.96
|
| Rate for Payer: Healthspan PPO |
$1,022.34
|
| Rate for Payer: Humana Medicaid |
$478.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,095.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$834.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.27
|
| Rate for Payer: Molina Healthcare Passport |
$478.70
|
| Rate for Payer: Multiplan PHCS |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.43
|
| Rate for Payer: UHCCP Medicaid |
$775.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$834.95
|
|
|
INCISION OF GALLBLADDER(P
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 47480
|
| Hospital Charge Code |
761P1954
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.70 |
| Max. Negotiated Rate |
$1,329.00 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Ambetter Exchange |
$834.95
|
| Rate for Payer: Anthem Medicaid |
$478.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$834.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$834.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,001.94
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cash Price |
$1,107.50
|
| Rate for Payer: Cigna Commercial |
$1,112.96
|
| Rate for Payer: Healthspan PPO |
$1,022.34
|
| Rate for Payer: Humana Medicaid |
$478.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,095.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$834.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$834.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.27
|
| Rate for Payer: Molina Healthcare Passport |
$478.70
|
| Rate for Payer: Multiplan PHCS |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.43
|
| Rate for Payer: UHCCP Medicaid |
$775.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$834.95
|
|
|
INCISION OF HEART SAC
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
76101238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.02 |
| Max. Negotiated Rate |
$1,458.13 |
| Rate for Payer: Aetna Commercial |
$1,458.13
|
| Rate for Payer: Ambetter Exchange |
$780.36
|
| Rate for Payer: Anthem Medicaid |
$742.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$780.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$936.43
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,371.08
|
| Rate for Payer: Healthspan PPO |
$1,433.63
|
| Rate for Payer: Humana Medicaid |
$742.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,218.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$780.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$756.86
|
| Rate for Payer: Molina Healthcare Passport |
$742.02
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,014.47
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$749.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$780.36
|
|
|
INCISION OF HEART SAC
|
Facility
|
IP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
76101238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
INCISION OF HEART SAC
|
Facility
|
OP
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
76101238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$660.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$1,694.00
|
| Rate for Payer: Anthem Medicaid |
$756.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,826.00
|
| Rate for Payer: First Health Commercial |
$2,090.00
|
| Rate for Payer: Humana Commercial |
$1,870.00
|
| Rate for Payer: Humana KY Medicaid |
$756.58
|
| Rate for Payer: Kentucky WC Medicaid |
$764.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,804.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$660.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,936.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,650.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,914.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,518.00
|
| Rate for Payer: PHCS Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare All Payer |
$1,936.00
|
|
|
INCISION OF HEART SAC(P
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 33020
|
| Hospital Charge Code |
761P1238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$742.02 |
| Max. Negotiated Rate |
$1,458.13 |
| Rate for Payer: Aetna Commercial |
$1,458.13
|
| Rate for Payer: Ambetter Exchange |
$780.36
|
| Rate for Payer: Anthem Medicaid |
$742.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$780.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$936.43
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cigna Commercial |
$1,371.08
|
| Rate for Payer: Healthspan PPO |
$1,433.63
|
| Rate for Payer: Humana Medicaid |
$742.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,218.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$780.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$756.86
|
| Rate for Payer: Molina Healthcare Passport |
$742.02
|
| Rate for Payer: Multiplan PHCS |
$1,320.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,014.47
|
| Rate for Payer: UHCCP Medicaid |
$770.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$749.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$780.36
|
|
|
INCISION OF HEEL BONE
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
76101005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.31 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$654.50
|
| Rate for Payer: Anthem Medicaid |
$292.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 HEEL BONE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
76101005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$1,099.80 |
| Rate for Payer: Aetna Commercial |
$1,005.86
|
| Rate for Payer: Ambetter Exchange |
$619.98
|
| Rate for Payer: Anthem Medicaid |
$461.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$619.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$619.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$743.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$619.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.98
|
| 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 |
$805.97
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$619.98
|
|
|
INCISION OF HEEL BONE
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
HCPCS 28300
|
| Hospital Charge Code |
76101005
|
|
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 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: Ambetter Exchange |
$619.98
|
| Rate for Payer: Anthem Medicaid |
$461.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$619.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$619.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$743.98
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$619.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.98
|
| 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 |
$805.97
|
| Rate for Payer: UHCCP Medicaid |
$297.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$466.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$619.98
|
|
|
INCISION OF HIP TENDONS
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
76100761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.39 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem Medicaid |
$316.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.80
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
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: Ambetter Exchange |
$678.68
|
| Rate for Payer: Anthem Medicaid |
$421.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$678.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$678.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$814.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$678.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.68
|
| 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 |
$882.28
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$678.68
|
|
|
INCISION OF HIP TENDONS
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 27006
|
| Hospital Charge Code |
76100761
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$883.20 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| 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: 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 |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.80
|
| 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: Ambetter Exchange |
$678.68
|
| Rate for Payer: Anthem Medicaid |
$421.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$678.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$678.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$814.42
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$678.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.68
|
| 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 |
$882.28
|
| Rate for Payer: UHCCP Medicaid |
$322.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$426.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$678.68
|
|
|
INCISION OF LINGUAL FRENUM
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
76101647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Aetna Commercial |
$151.90
|
| Rate for Payer: Ambetter Exchange |
$101.66
|
| 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 Individual/Medicaid |
$101.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.99
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$101.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.73
|
| Rate for Payer: Molina Healthcare Passport |
$45.81
|
| Rate for Payer: Multiplan PHCS |
$1,767.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.16
|
| Rate for Payer: UHCCP Medicaid |
$62.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.66
|
|
