|
PARTIAL REMOVAL FOOT FASCIA
|
Professional
|
Both
|
$5,732.25
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
76100972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$5,732.25 |
| Rate for Payer: Aetna Commercial |
$548.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.93
|
| Rate for Payer: Anthem Medicaid |
$274.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,732.25
|
| Rate for Payer: Cash Price |
$2,866.12
|
| Rate for Payer: Cash Price |
$2,866.12
|
| Rate for Payer: Cigna Commercial |
$600.02
|
| Rate for Payer: Healthspan PPO |
$640.26
|
| Rate for Payer: Humana Medicaid |
$274.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.74
|
| Rate for Payer: Molina Healthcare Passport |
$274.25
|
| Rate for Payer: Multiplan PHCS |
$3,439.35
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,012.58
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.99
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
IP
|
$5,732.25
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
76100972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$745.19 |
| Max. Negotiated Rate |
$5,502.96 |
| Rate for Payer: Aetna Commercial |
$4,413.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,471.16
|
| Rate for Payer: Cash Price |
$2,866.12
|
| Rate for Payer: Cigna Commercial |
$4,757.77
|
| Rate for Payer: First Health Commercial |
$5,445.64
|
| Rate for Payer: Humana Commercial |
$4,872.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,700.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,230.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,719.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,044.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,299.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$745.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,777.00
|
| Rate for Payer: PHCS Commercial |
$5,502.96
|
| Rate for Payer: United Healthcare All Payer |
$5,044.38
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
OP
|
$5,732.25
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
76100972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$745.19 |
| Max. Negotiated Rate |
$5,502.96 |
| Rate for Payer: Aetna Commercial |
$4,413.83
|
| Rate for Payer: Anthem Medicaid |
$1,971.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,471.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,866.12
|
| Rate for Payer: Cash Price |
$2,866.12
|
| Rate for Payer: Cigna Commercial |
$4,757.77
|
| Rate for Payer: First Health Commercial |
$5,445.64
|
| Rate for Payer: Humana Commercial |
$4,872.41
|
| Rate for Payer: Humana KY Medicaid |
$1,971.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,991.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,700.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,230.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,010.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,044.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,299.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,146.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$745.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,777.00
|
| Rate for Payer: PHCS Commercial |
$5,502.96
|
| Rate for Payer: United Healthcare All Payer |
$5,044.38
|
|
|
PARTIAL REMOVAL FOOT FASCIA(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
761P0972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$548.42
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$183.93
|
| Rate for Payer: Anthem Medicaid |
$274.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$600.02
|
| Rate for Payer: Healthspan PPO |
$640.26
|
| Rate for Payer: Humana Medicaid |
$274.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.74
|
| Rate for Payer: Molina Healthcare Passport |
$274.25
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.99
|
|
|
PARTIAL REMOVAL FOOT FASCIA(T
|
Facility
|
IP
|
$4,832.25
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
761T0972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$628.19 |
| Max. Negotiated Rate |
$4,638.96 |
| Rate for Payer: Aetna Commercial |
$3,720.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,769.16
|
| Rate for Payer: Cash Price |
$2,416.12
|
| Rate for Payer: Cigna Commercial |
$4,010.77
|
| Rate for Payer: First Health Commercial |
$4,590.64
|
| Rate for Payer: Humana Commercial |
$4,107.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,962.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,566.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,449.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,252.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,624.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$966.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$628.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.00
|
| Rate for Payer: PHCS Commercial |
$4,638.96
|
| Rate for Payer: United Healthcare All Payer |
$4,252.38
|
|
|
PARTIAL REMOVAL FOOT FASCIA(T
|
Facility
|
OP
|
$4,832.25
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
761T0972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$628.19 |
| Max. Negotiated Rate |
$4,638.96 |
| Rate for Payer: Aetna Commercial |
$3,720.83
|
| Rate for Payer: Anthem Medicaid |
$1,661.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,769.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,416.12
|
| Rate for Payer: Cash Price |
$2,416.12
|
| Rate for Payer: Cigna Commercial |
$4,010.77
|
| Rate for Payer: First Health Commercial |
$4,590.64
|
| Rate for Payer: Humana Commercial |
$4,107.41
|
| Rate for Payer: Humana KY Medicaid |
$1,661.81
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,678.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,962.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,566.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,695.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,252.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,624.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$966.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$628.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,498.00
|
| Rate for Payer: PHCS Commercial |
$4,638.96
|
| Rate for Payer: United Healthcare All Payer |
$4,252.38
|
|
|
PARTIAL REMOVAL LEG BONE(S)
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
HCPCS 27360
|
| Hospital Charge Code |
76102651
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.45 |
| Max. Negotiated Rate |
$2,443.00 |
| Rate for Payer: Aetna Commercial |
$1,245.36
|
| Rate for Payer: Anthem Medicaid |
$534.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,443.00
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cash Price |
$1,221.50
|
| Rate for Payer: Cigna Commercial |
$1,372.12
|
| Rate for Payer: Healthspan PPO |
$1,128.03
|
| Rate for Payer: Humana Medicaid |
$534.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,053.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.14
|
| Rate for Payer: Molina Healthcare Passport |
$534.45
|
| Rate for Payer: Multiplan PHCS |
$1,465.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,710.10
|
| Rate for Payer: UHCCP Medicaid |
$855.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$539.79
|
|
|
PARTIAL REMOVAL OF FIBULA
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27641
|
| Hospital Charge Code |
76102884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Humana KY Medicaid |
$554.71
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$560.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$565.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
PARTIAL REMOVAL OF FIBULA
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27641
|
| Hospital Charge Code |
76102884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$209.69 |
| Max. Negotiated Rate |
$1,548.48 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,338.79
|
| Rate for Payer: First Health Commercial |
$1,532.35
|
| Rate for Payer: Humana Commercial |
$1,371.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,322.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,190.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$483.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,419.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,209.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$322.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$500.03
|
| Rate for Payer: PHCS Commercial |
$1,548.48
|
| Rate for Payer: United Healthcare All Payer |
$1,419.44
|
|
|
PARTIAL REMOVAL OF FIBULA
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27641
|
| Hospital Charge Code |
76102884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.23 |
| Max. Negotiated Rate |
$1,613.00 |
| Rate for Payer: Aetna Commercial |
$1,025.29
|
| Rate for Payer: Anthem Medicaid |
$465.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,613.00
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cash Price |
$806.50
|
| Rate for Payer: Cigna Commercial |
$1,173.72
|
| Rate for Payer: Healthspan PPO |
$928.70
|
| Rate for Payer: Humana Medicaid |
$465.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$844.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.53
|
| Rate for Payer: Molina Healthcare Passport |
$465.23
|
| Rate for Payer: Multiplan PHCS |
$967.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,129.10
|
| Rate for Payer: UHCCP Medicaid |
$564.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.88
|
|
|
PARTIAL REMOVAL OF HAND BONE
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
76100683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem Medicaid |
$423.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Humana KY Medicaid |
$423.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$427.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$431.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.30
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
PARTIAL REMOVAL OF HAND BONE
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
76100683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$724.40
|
| Rate for Payer: Anthem Medicaid |
$305.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,230.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$803.12
|
| Rate for Payer: Healthspan PPO |
$656.15
|
| Rate for Payer: Humana Medicaid |
$305.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.04
|
| Rate for Payer: Molina Healthcare Passport |
$305.92
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$861.00
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.98
|
|
|
PARTIAL REMOVAL OF HAND BONE
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
76100683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$1,180.80 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.30
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
PARTIAL REMOVAL OF HAND BON(P
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26230
|
| Hospital Charge Code |
761P0683
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$724.40
|
| Rate for Payer: Anthem Medicaid |
$305.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,230.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$803.12
|
| Rate for Payer: Healthspan PPO |
$656.15
|
| Rate for Payer: Humana Medicaid |
$305.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.04
|
| Rate for Payer: Molina Healthcare Passport |
$305.92
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$861.00
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$308.98
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
76102163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
76102163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$278.22
|
| Rate for Payer: Anthem Medicaid |
$128.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$271.91
|
| Rate for Payer: Healthspan PPO |
$269.39
|
| Rate for Payer: Humana Medicaid |
$128.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.90
|
| Rate for Payer: Molina Healthcare Passport |
$128.33
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.61
|
|
|
PARTIAL REMOVAL OF HYMEN
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
76102163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
PARTIAL REMOVAL OF HYMEN(P
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 56700
|
| Hospital Charge Code |
761P2163
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.33 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$278.22
|
| Rate for Payer: Anthem Medicaid |
$128.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$271.91
|
| Rate for Payer: Healthspan PPO |
$269.39
|
| Rate for Payer: Humana Medicaid |
$128.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.90
|
| Rate for Payer: Molina Healthcare Passport |
$128.33
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$129.61
|
|
|
PARTIAL REMOVAL OF KIDNEY
|
Professional
|
Both
|
$3,238.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
76102896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,064.37 |
| Max. Negotiated Rate |
$3,238.00 |
| Rate for Payer: Aetna Commercial |
$2,155.89
|
| Rate for Payer: Anthem Medicaid |
$1,064.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,238.00
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cigna Commercial |
$1,912.83
|
| Rate for Payer: Healthspan PPO |
$1,723.83
|
| Rate for Payer: Humana Medicaid |
$1,064.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,806.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,085.66
|
| Rate for Payer: Molina Healthcare Passport |
$1,064.37
|
| Rate for Payer: Multiplan PHCS |
$1,942.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,266.60
|
| Rate for Payer: UHCCP Medicaid |
$1,133.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,075.01
|
|
|
PARTIAL REMOVAL OF KIDNEY
|
Facility
|
OP
|
$3,238.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
76102896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.94 |
| Max. Negotiated Rate |
$3,108.48 |
| Rate for Payer: Aetna Commercial |
$2,493.26
|
| Rate for Payer: Anthem Medicaid |
$1,113.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.64
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cigna Commercial |
$2,687.54
|
| Rate for Payer: First Health Commercial |
$3,076.10
|
| Rate for Payer: Humana Commercial |
$2,752.30
|
| Rate for Payer: Humana KY Medicaid |
$1,113.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,124.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,655.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,135.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,003.78
|
| Rate for Payer: PHCS Commercial |
$3,108.48
|
| Rate for Payer: United Healthcare All Payer |
$2,849.44
|
|
|
PARTIAL REMOVAL OF KIDNEY
|
Facility
|
IP
|
$3,238.00
|
|
|
Service Code
|
HCPCS 50240
|
| Hospital Charge Code |
76102896
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.94 |
| Max. Negotiated Rate |
$3,108.48 |
| Rate for Payer: Aetna Commercial |
$2,493.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,525.64
|
| Rate for Payer: Cash Price |
$1,619.00
|
| Rate for Payer: Cigna Commercial |
$2,687.54
|
| Rate for Payer: First Health Commercial |
$3,076.10
|
| Rate for Payer: Humana Commercial |
$2,752.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,655.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,389.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$971.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,849.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,428.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$647.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,003.78
|
| Rate for Payer: PHCS Commercial |
$3,108.48
|
| Rate for Payer: United Healthcare All Payer |
$2,849.44
|
|
|
PARTIAL REMOVAL OF PENIS
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS 54120
|
| Hospital Charge Code |
76102831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$590.40 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$184.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
PARTIAL REMOVAL OF PENIS
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS 54120
|
| Hospital Charge Code |
76102831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$4,220.54 |
| Rate for Payer: Aetna Commercial |
$473.55
|
| Rate for Payer: Anthem Medicaid |
$211.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,014.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,220.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,069.80
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$510.45
|
| Rate for Payer: First Health Commercial |
$584.25
|
| Rate for Payer: Humana Commercial |
$522.75
|
| Rate for Payer: Humana KY Medicaid |
$211.50
|
| Rate for Payer: Humana Medicare Advantage |
$3,014.67
|
| Rate for Payer: Kentucky WC Medicaid |
$213.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$504.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$453.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,617.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$541.20
|
| Rate for Payer: Ohio Health Group HMO |
$461.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$123.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.65
|
| Rate for Payer: PHCS Commercial |
$590.40
|
| Rate for Payer: United Healthcare All Payer |
$541.20
|
|
|
PARTIAL REMOVAL OF PENIS
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 54120
|
| Hospital Charge Code |
76102831
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.25 |
| Max. Negotiated Rate |
$1,022.83 |
| Rate for Payer: Aetna Commercial |
$1,022.83
|
| Rate for Payer: Anthem Medicaid |
$459.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$615.00
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$904.94
|
| Rate for Payer: Healthspan PPO |
$990.36
|
| Rate for Payer: Humana Medicaid |
$459.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$860.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.93
|
| Rate for Payer: Molina Healthcare Passport |
$459.74
|
| Rate for Payer: Multiplan PHCS |
$369.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.50
|
| Rate for Payer: UHCCP Medicaid |
$215.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$464.34
|
|
|
PARTIAL REMOVAL OF RADIUS
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 25151
|
| Hospital Charge Code |
76100590
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$380.31 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$924.55
|
| Rate for Payer: Anthem Medicaid |
$380.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,440.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cigna Commercial |
$1,257.56
|
| Rate for Payer: Healthspan PPO |
$837.45
|
| Rate for Payer: Humana Medicaid |
$380.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$387.92
|
| Rate for Payer: Molina Healthcare Passport |
$380.31
|
| Rate for Payer: Multiplan PHCS |
$864.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,008.00
|
| Rate for Payer: UHCCP Medicaid |
$504.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$384.11
|
|
