|
PARTIAL REMOVAL OF ULNA
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
76100593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: Anthem Medicaid |
$307.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$772.59
|
| Rate for Payer: Healthspan PPO |
$575.33
|
| Rate for Payer: Humana Medicaid |
$307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$532.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$313.27
|
| Rate for Payer: Molina Healthcare Passport |
$307.13
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$310.20
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 25150
|
| Hospital Charge Code |
76100589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$1,141.25
|
| Rate for Payer: First Health Commercial |
$1,306.25
|
| Rate for Payer: Humana Commercial |
$1,168.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,127.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,210.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$275.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$178.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.25
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
76100593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PARTIAL REMOVAL OF ULNA
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 25150
|
| Hospital Charge Code |
76100589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.61 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$839.61
|
| Rate for Payer: Anthem Medicaid |
$398.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$993.23
|
| Rate for Payer: Healthspan PPO |
$760.51
|
| Rate for Payer: Humana Medicaid |
$398.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.58
|
| Rate for Payer: Molina Healthcare Passport |
$398.61
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$962.50
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.60
|
|
|
PARTIAL REMOVAL OF ULNA(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
761P0593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.13 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: Anthem Medicaid |
$307.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$772.59
|
| Rate for Payer: Healthspan PPO |
$575.33
|
| Rate for Payer: Humana Medicaid |
$307.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$532.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$313.27
|
| Rate for Payer: Molina Healthcare Passport |
$307.13
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$310.20
|
|
|
PARTIAL REMOVAL OF ULNA(P
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 25150
|
| Hospital Charge Code |
761P0589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$398.61 |
| Max. Negotiated Rate |
$1,375.00 |
| Rate for Payer: Aetna Commercial |
$839.61
|
| Rate for Payer: Anthem Medicaid |
$398.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,375.00
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cash Price |
$687.50
|
| Rate for Payer: Cigna Commercial |
$993.23
|
| Rate for Payer: Healthspan PPO |
$760.51
|
| Rate for Payer: Humana Medicaid |
$398.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$704.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.58
|
| Rate for Payer: Molina Healthcare Passport |
$398.61
|
| Rate for Payer: Multiplan PHCS |
$825.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$962.50
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.60
|
|
|
PARTIAL THYROID EXCISION
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 60212
|
| Hospital Charge Code |
76102272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$1,479.69 |
| Rate for Payer: Aetna Commercial |
$1,479.69
|
| Rate for Payer: Anthem Medicaid |
$738.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,388.04
|
| Rate for Payer: Healthspan PPO |
$1,247.85
|
| Rate for Payer: Humana Medicaid |
$738.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,303.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$753.77
|
| Rate for Payer: Molina Healthcare Passport |
$738.99
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.38
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 60212
|
| Hospital Charge Code |
76102272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 60212
|
| Hospital Charge Code |
76102272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$158.60 |
| Max. Negotiated Rate |
$6,985.45 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,989.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,985.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,735.97
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Humana Medicare Advantage |
$4,989.61
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,987.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.20
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
PARTIAL THYROID EXCISION(P
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 60212
|
| Hospital Charge Code |
761P2272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$1,479.69 |
| Rate for Payer: Aetna Commercial |
$1,479.69
|
| Rate for Payer: Anthem Medicaid |
$738.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,220.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,388.04
|
| Rate for Payer: Healthspan PPO |
$1,247.85
|
| Rate for Payer: Humana Medicaid |
$738.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,303.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$753.77
|
| Rate for Payer: Molina Healthcare Passport |
$738.99
|
| Rate for Payer: Multiplan PHCS |
$732.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$854.00
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.38
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
HCPCS 28120
|
| Hospital Charge Code |
76100986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$1,420.80 |
| Rate for Payer: Aetna Commercial |
$1,139.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,154.40
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cigna Commercial |
$1,228.40
|
| Rate for Payer: First Health Commercial |
$1,406.00
|
| Rate for Payer: Humana Commercial |
$1,258.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,213.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,092.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$444.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,302.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$458.80
|
| Rate for Payer: PHCS Commercial |
$1,420.80
|
| Rate for Payer: United Healthcare All Payer |
$1,302.40
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
HCPCS 28120
|
| Hospital Charge Code |
76100986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,139.60
|
| Rate for Payer: Anthem Medicaid |
$508.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,154.40
|
| 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 |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cigna Commercial |
$1,228.40
|
| Rate for Payer: First Health Commercial |
$1,406.00
|
| Rate for Payer: Humana Commercial |
$1,258.00
|
| Rate for Payer: Humana KY Medicaid |
$508.97
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$514.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,213.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,092.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$519.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,302.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,110.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$192.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$458.80
|
| Rate for Payer: PHCS Commercial |
$1,420.80
|
| Rate for Payer: United Healthcare All Payer |
$1,302.40
|
|
|
PART REMOVAL OF ANKLE/HEEL
|
Professional
|
Both
|
$1,480.00
|
|
|
Service Code
|
HCPCS 28120
|
| Hospital Charge Code |
76100986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.84 |
| Max. Negotiated Rate |
$1,480.00 |
| Rate for Payer: Aetna Commercial |
$597.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.84
|
| Rate for Payer: Anthem Medicaid |
$292.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,480.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cigna Commercial |
$656.37
|
| Rate for Payer: Healthspan PPO |
$720.27
|
| Rate for Payer: Humana Medicaid |
$292.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$653.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.45
|
| Rate for Payer: Molina Healthcare Passport |
$292.60
|
| Rate for Payer: Multiplan PHCS |
$888.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,036.00
|
| Rate for Payer: UHCCP Medicaid |
$266.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.53
|
|
|
PART REMOVAL OF ANKLE/HEEL(P
|
Professional
|
Both
|
$1,480.00
|
|
|
Service Code
|
HCPCS 28120
|
| Hospital Charge Code |
761P0986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.84 |
| Max. Negotiated Rate |
$1,480.00 |
| Rate for Payer: Aetna Commercial |
$597.70
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.84
|
| Rate for Payer: Anthem Medicaid |
$292.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,480.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cash Price |
$740.00
|
| Rate for Payer: Cigna Commercial |
$656.37
|
| Rate for Payer: Healthspan PPO |
$720.27
|
| Rate for Payer: Humana Medicaid |
$292.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$653.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$298.45
|
| Rate for Payer: Molina Healthcare Passport |
$292.60
|
| Rate for Payer: Multiplan PHCS |
$888.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,036.00
|
| Rate for Payer: UHCCP Medicaid |
$266.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.53
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
76100979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
PART REMOVAL OF METATARSAL
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 28113
|
| Hospital Charge Code |
76100982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.95 |
| Max. Negotiated Rate |
$719.45 |
| Rate for Payer: Aetna Commercial |
$625.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$215.95
|
| Rate for Payer: Anthem Medicaid |
$250.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$668.31
|
| Rate for Payer: Healthspan PPO |
$719.45
|
| Rate for Payer: Humana Medicaid |
$250.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.79
|
| Rate for Payer: Molina Healthcare Passport |
$250.77
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$226.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.28
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 28113
|
| Hospital Charge Code |
76100982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
76100979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
PART REMOVAL OF METATARSAL
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
76100979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.77 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$441.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.77
|
| Rate for Payer: Anthem Medicaid |
$214.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$481.67
|
| Rate for Payer: Healthspan PPO |
$558.61
|
| Rate for Payer: Humana Medicaid |
$214.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$355.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.21
|
| Rate for Payer: Molina Healthcare Passport |
$214.91
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$155.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.06
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 28113
|
| Hospital Charge Code |
76100982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| 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 |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$214.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.75
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
PART REMOVAL OF METATARSAL(P
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 28113
|
| Hospital Charge Code |
761P0982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.95 |
| Max. Negotiated Rate |
$719.45 |
| Rate for Payer: Aetna Commercial |
$625.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$215.95
|
| Rate for Payer: Anthem Medicaid |
$250.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.00
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$668.31
|
| Rate for Payer: Healthspan PPO |
$719.45
|
| Rate for Payer: Humana Medicaid |
$250.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$255.79
|
| Rate for Payer: Molina Healthcare Passport |
$250.77
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$437.50
|
| Rate for Payer: UHCCP Medicaid |
$226.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.28
|
|
|
PART REMOVAL OF METATARSAL(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
761P0979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.77 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$441.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$147.77
|
| Rate for Payer: Anthem Medicaid |
$214.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$481.67
|
| Rate for Payer: Healthspan PPO |
$558.61
|
| Rate for Payer: Humana Medicaid |
$214.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$355.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.21
|
| Rate for Payer: Molina Healthcare Passport |
$214.91
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$155.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.06
|
|
|
PART REMOVE HIP BONE SUPER
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 27070
|
| Hospital Charge Code |
76100772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.26 |
| Max. Negotiated Rate |
$1,580.00 |
| Rate for Payer: Aetna Commercial |
$1,239.91
|
| Rate for Payer: Anthem Medicaid |
$509.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,580.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,349.95
|
| Rate for Payer: Healthspan PPO |
$1,123.10
|
| Rate for Payer: Humana Medicaid |
$509.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,054.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$519.45
|
| Rate for Payer: Molina Healthcare Passport |
$509.26
|
| Rate for Payer: Multiplan PHCS |
$948.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,106.00
|
| Rate for Payer: UHCCP Medicaid |
$553.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.35
|
|
|
PART REMOVE HIP BONE SUPER
|
Facility
|
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 27070
|
| Hospital Charge Code |
76100772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$1,516.80 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.80
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
PART REMOVE HIP BONE SUPER
|
Facility
|
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS 27070
|
| Hospital Charge Code |
76100772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$1,516.80 |
| Rate for Payer: Aetna Commercial |
$1,216.60
|
| Rate for Payer: Anthem Medicaid |
$543.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.40
|
| Rate for Payer: Cash Price |
$790.00
|
| Rate for Payer: Cigna Commercial |
$1,311.40
|
| Rate for Payer: First Health Commercial |
$1,501.00
|
| Rate for Payer: Humana Commercial |
$1,343.00
|
| Rate for Payer: Humana KY Medicaid |
$543.36
|
| Rate for Payer: Kentucky WC Medicaid |
$548.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.80
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
