|
INCISION OF LINGUAL FRENUM
|
Facility
|
OP
|
$2,946.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
76101647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,013.13 |
| Max. Negotiated Rate |
$2,828.16 |
| Rate for Payer: Aetna Commercial |
$2,268.42
|
| Rate for Payer: Anthem Medicaid |
$1,013.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,297.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cigna Commercial |
$2,445.18
|
| Rate for Payer: First Health Commercial |
$2,798.70
|
| Rate for Payer: Humana Commercial |
$2,504.10
|
| Rate for Payer: Humana KY Medicaid |
$1,013.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,023.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,415.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,174.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,033.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,592.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,209.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,563.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,032.74
|
| Rate for Payer: PHCS Commercial |
$2,828.16
|
| Rate for Payer: United Healthcare All Payer |
$2,592.48
|
|
|
INCISION OF LINGUAL FRENUM
|
Facility
|
IP
|
$2,946.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
76101647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$883.80 |
| Max. Negotiated Rate |
$2,828.16 |
| Rate for Payer: Aetna Commercial |
$2,268.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,297.88
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cigna Commercial |
$2,445.18
|
| Rate for Payer: First Health Commercial |
$2,798.70
|
| Rate for Payer: Humana Commercial |
$2,504.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,415.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,174.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,592.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,209.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,563.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,032.74
|
| Rate for Payer: PHCS Commercial |
$2,828.16
|
| Rate for Payer: United Healthcare All Payer |
$2,592.48
|
|
|
INCISION OF LINGUAL FRENUM(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
761P1647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$255.78 |
| Rate for Payer: Aetna Commercial |
$151.90
|
| Rate for Payer: 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 |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$255.78
|
| Rate for Payer: Healthspan PPO |
$226.95
|
| Rate for Payer: Humana Medicaid |
$45.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.36
|
| Rate for Payer: 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 |
$150.00
|
| 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
|
|
|
INCISION OF LINGUAL FRENUM(T
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
761T1647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$927.15 |
| Max. Negotiated Rate |
$2,588.16 |
| Rate for Payer: Aetna Commercial |
$2,075.92
|
| Rate for Payer: Anthem Medicaid |
$927.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,368.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,916.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna Commercial |
$2,237.68
|
| Rate for Payer: First Health Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial |
$2,291.60
|
| Rate for Payer: Humana KY Medicaid |
$927.15
|
| Rate for Payer: Humana Medicare Advantage |
$1,368.67
|
| Rate for Payer: Kentucky WC Medicaid |
$936.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,210.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,989.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$945.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,372.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,022.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.24
|
| Rate for Payer: PHCS Commercial |
$2,588.16
|
| Rate for Payer: United Healthcare All Payer |
$2,372.48
|
|
|
INCISION OF LINGUAL FRENUM(T
|
Facility
|
IP
|
$2,696.00
|
|
|
Service Code
|
HCPCS 41010
|
| Hospital Charge Code |
761T1647
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$2,588.16 |
| Rate for Payer: Aetna Commercial |
$2,075.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,102.88
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Cigna Commercial |
$2,237.68
|
| Rate for Payer: First Health Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial |
$2,291.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,210.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,989.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$808.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,372.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,022.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,345.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,860.24
|
| Rate for Payer: PHCS Commercial |
$2,588.16
|
| Rate for Payer: United Healthcare All Payer |
$2,372.48
|
|
|
INCISION OF LIP FOLD
|
Facility
|
OP
|
$933.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
76101633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$320.86 |
| Max. Negotiated Rate |
$895.68 |
| Rate for Payer: Aetna Commercial |
$718.41
|
| Rate for Payer: Anthem Medicaid |
$320.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$727.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$774.39
|
| Rate for Payer: First Health Commercial |
$886.35
|
| Rate for Payer: Humana Commercial |
$793.05
|
| Rate for Payer: Humana KY Medicaid |
$320.86
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$324.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$688.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$327.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.04
|
| Rate for Payer: Ohio Health Group HMO |
$699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.77
|
| Rate for Payer: PHCS Commercial |
$895.68
|
| Rate for Payer: United Healthcare All Payer |
$821.04
|
|
|
INCISION OF LIP FOLD
|
Facility
|
IP
|
$933.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
76101633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$279.90 |
| Max. Negotiated Rate |
$895.68 |
| Rate for Payer: Aetna Commercial |
$718.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$727.74
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$774.39
|
| Rate for Payer: First Health Commercial |
$886.35
|
| Rate for Payer: Humana Commercial |
$793.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$765.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$688.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$821.04
|
| Rate for Payer: Ohio Health Group HMO |
$699.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$811.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$643.77
|
| Rate for Payer: PHCS Commercial |
$895.68
|
| Rate for Payer: United Healthcare All Payer |
$821.04
|
|
|
INCISION OF LIP FOLD
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
76101633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$559.80 |
| Rate for Payer: Aetna Commercial |
$48.04
|
| Rate for Payer: Ambetter Exchange |
$27.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.12
|
| Rate for Payer: Anthem Medicaid |
$19.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.44
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Cigna Commercial |
$130.75
|
| Rate for Payer: Healthspan PPO |
$119.04
|
| Rate for Payer: Humana Medicaid |
$19.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.87
|
| Rate for Payer: Molina Healthcare Passport |
$19.48
|
| Rate for Payer: Multiplan PHCS |
$559.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.23
|
| Rate for Payer: UHCCP Medicaid |
$22.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.87
|
|
|
INCISION OF LIP FOLD(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
761P1633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$48.04
|
| Rate for Payer: Ambetter Exchange |
$27.87
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$21.12
|
| Rate for Payer: Anthem Medicaid |
$19.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$27.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$27.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.44
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$130.75
|
| Rate for Payer: Healthspan PPO |
$119.04
|
| Rate for Payer: Humana Medicaid |
$19.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$27.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.87
|
| Rate for Payer: Molina Healthcare Passport |
$19.48
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.23
|
| Rate for Payer: UHCCP Medicaid |
$22.18
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$27.87
|
|
|
INCISION OF LIP FOLD(T
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
761T1633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.90 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INCISION OF LIP FOLD(T
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 40806
|
| Hospital Charge Code |
761T1633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.69 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
INCISION OF METATARSAL
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
76101007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.50 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
INCISION OF METATARSAL
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
76101007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.74 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$442.75
|
| Rate for Payer: Anthem Medicaid |
$197.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$448.50
|
| 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 |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$477.25
|
| Rate for Payer: First Health Commercial |
$546.25
|
| Rate for Payer: Humana Commercial |
$488.75
|
| Rate for Payer: Humana KY Medicaid |
$197.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$471.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$424.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$201.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$506.00
|
| Rate for Payer: Ohio Health Group HMO |
$431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$396.75
|
| Rate for Payer: PHCS Commercial |
$552.00
|
| Rate for Payer: United Healthcare All Payer |
$506.00
|
|
|
INCISION OF METATARSAL
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
76101007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$678.34 |
| Rate for Payer: Aetna Commercial |
$562.10
|
| Rate for Payer: Ambetter Exchange |
$368.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$196.22
|
| Rate for Payer: Anthem Medicaid |
$314.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$368.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$368.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.74
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$599.04
|
| Rate for Payer: Healthspan PPO |
$678.34
|
| Rate for Payer: Humana Medicaid |
$314.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$368.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$368.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare Passport |
$314.66
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.56
|
| Rate for Payer: UHCCP Medicaid |
$206.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$368.12
|
|
|
INCISION OF METATARSAL(P
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 28308
|
| Hospital Charge Code |
761P1007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$678.34 |
| Rate for Payer: Aetna Commercial |
$562.10
|
| Rate for Payer: Ambetter Exchange |
$368.12
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$196.22
|
| Rate for Payer: Anthem Medicaid |
$314.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$368.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$368.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$441.74
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cash Price |
$287.50
|
| Rate for Payer: Cigna Commercial |
$599.04
|
| Rate for Payer: Healthspan PPO |
$678.34
|
| Rate for Payer: Humana Medicaid |
$314.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$461.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$368.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$368.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$320.95
|
| Rate for Payer: Molina Healthcare Passport |
$314.66
|
| Rate for Payer: Multiplan PHCS |
$345.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$478.56
|
| Rate for Payer: UHCCP Medicaid |
$206.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$317.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$368.12
|
|
|
INCISION OF PROSTATE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 52450
|
| Hospital Charge Code |
76102960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.49 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
INCISION OF PROSTATE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 52450
|
| Hospital Charge Code |
76102960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
INCISION OF PROSTATE
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 52450
|
| Hospital Charge Code |
76102960
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.62 |
| Max. Negotiated Rate |
$756.71 |
| Rate for Payer: Aetna Commercial |
$756.71
|
| Rate for Payer: Ambetter Exchange |
$450.15
|
| Rate for Payer: Anthem Medicaid |
$352.62
|
| Rate for Payer: Buckeye Individual/Medicaid |
$450.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$540.18
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$664.45
|
| Rate for Payer: Healthspan PPO |
$605.06
|
| Rate for Payer: Humana Medicaid |
$352.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$637.54
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$450.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$359.67
|
| Rate for Payer: Molina Healthcare Passport |
$352.62
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$585.20
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$450.15
|
|
|
INCISION OF SPINAL NERVE
|
Facility
|
IP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
76102367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$1,435.20 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$448.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
INCISION OF SPINAL NERVE
|
Professional
|
Both
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
76102367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.42 |
| Max. Negotiated Rate |
$903.55 |
| Rate for Payer: Aetna Commercial |
$903.55
|
| Rate for Payer: Ambetter Exchange |
$529.58
|
| Rate for Payer: Anthem Medicaid |
$412.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$529.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$529.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$801.01
|
| Rate for Payer: Healthspan PPO |
$705.47
|
| Rate for Payer: Humana Medicaid |
$412.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$734.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$529.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.67
|
| Rate for Payer: Molina Healthcare Passport |
$412.42
|
| Rate for Payer: Multiplan PHCS |
$897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$688.45
|
| Rate for Payer: UHCCP Medicaid |
$523.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$529.58
|
|
|
INCISION OF SPINAL NERVE
|
Facility
|
OP
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
76102367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$514.13 |
| Max. Negotiated Rate |
$2,526.05 |
| Rate for Payer: Aetna Commercial |
$1,151.15
|
| Rate for Payer: Anthem Medicaid |
$514.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,804.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,166.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,526.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,435.83
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$1,240.85
|
| Rate for Payer: First Health Commercial |
$1,420.25
|
| Rate for Payer: Humana Commercial |
$1,270.75
|
| Rate for Payer: Humana KY Medicaid |
$514.13
|
| Rate for Payer: Humana Medicare Advantage |
$1,804.32
|
| Rate for Payer: Kentucky WC Medicaid |
$519.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,225.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,103.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$524.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,315.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,121.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,300.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.55
|
| Rate for Payer: PHCS Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare All Payer |
$1,315.60
|
|
|
INCISION OF SPINAL NERVE(P
|
Professional
|
Both
|
$1,495.00
|
|
|
Service Code
|
HCPCS 64772
|
| Hospital Charge Code |
761P2367
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.42 |
| Max. Negotiated Rate |
$903.55 |
| Rate for Payer: Aetna Commercial |
$903.55
|
| Rate for Payer: Ambetter Exchange |
$529.58
|
| Rate for Payer: Anthem Medicaid |
$412.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$529.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$529.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cash Price |
$747.50
|
| Rate for Payer: Cigna Commercial |
$801.01
|
| Rate for Payer: Healthspan PPO |
$705.47
|
| Rate for Payer: Humana Medicaid |
$412.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$734.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$529.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$420.67
|
| Rate for Payer: Molina Healthcare Passport |
$412.42
|
| Rate for Payer: Multiplan PHCS |
$897.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$688.45
|
| Rate for Payer: UHCCP Medicaid |
$523.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$416.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$529.58
|
|
|
INCISION OF TENDON & MUSCLE
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$1,015.82 |
| Rate for Payer: Aetna Commercial |
$928.11
|
| Rate for Payer: Ambetter Exchange |
$584.91
|
| Rate for Payer: Anthem Medicaid |
$458.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$584.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$584.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$701.89
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,015.82
|
| Rate for Payer: Healthspan PPO |
$840.67
|
| Rate for Payer: Humana Medicaid |
$458.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$777.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$584.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.00
|
| Rate for Payer: Molina Healthcare Passport |
$458.82
|
| Rate for Payer: Multiplan PHCS |
$972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$760.38
|
| Rate for Payer: UHCCP Medicaid |
$567.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$584.91
|
|
|
INCISION OF TENDON & MUSCLE
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,555.20 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$486.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,409.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.80
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
|
INCISION OF TENDON & MUSCLE
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
76100455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$557.12 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Anthem Medicaid |
$557.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,263.60
|
| 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 |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,344.60
|
| Rate for Payer: First Health Commercial |
$1,539.00
|
| Rate for Payer: Humana Commercial |
$1,377.00
|
| Rate for Payer: Humana KY Medicaid |
$557.12
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$562.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,328.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,195.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$568.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,425.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,215.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,409.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.80
|
| Rate for Payer: PHCS Commercial |
$1,555.20
|
| Rate for Payer: United Healthcare All Payer |
$1,425.60
|
|
