|
PARTIAL HIP REPLACEMENT
|
Professional
|
Both
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27125
|
| Hospital Charge Code |
76100780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$914.33 |
| Max. Negotiated Rate |
$2,121.00 |
| Rate for Payer: Aetna Commercial |
$1,675.50
|
| Rate for Payer: Ambetter Exchange |
$1,075.22
|
| Rate for Payer: Anthem Medicaid |
$914.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,075.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,290.26
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$1,799.42
|
| Rate for Payer: Healthspan PPO |
$1,517.64
|
| Rate for Payer: Humana Medicaid |
$914.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,416.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,075.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$932.62
|
| Rate for Payer: Molina Healthcare Passport |
$914.33
|
| Rate for Payer: Multiplan PHCS |
$2,121.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,397.79
|
| Rate for Payer: UHCCP Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$923.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,075.22
|
|
|
PARTIAL HIP REPLACEMENT
|
Facility
|
IP
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27125
|
| Hospital Charge Code |
76100780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.50 |
| Max. Negotiated Rate |
$3,393.60 |
| Rate for Payer: Aetna Commercial |
$2,721.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.30
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$2,934.05
|
| Rate for Payer: First Health Commercial |
$3,358.25
|
| Rate for Payer: Humana Commercial |
$3,004.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,075.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.15
|
| Rate for Payer: PHCS Commercial |
$3,393.60
|
| Rate for Payer: United Healthcare All Payer |
$3,110.80
|
|
|
PARTIAL HIP REPLACEMENT
|
Facility
|
OP
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27125
|
| Hospital Charge Code |
76100780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.50 |
| Max. Negotiated Rate |
$3,393.60 |
| Rate for Payer: Aetna Commercial |
$2,721.95
|
| Rate for Payer: Anthem Medicaid |
$1,215.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,757.30
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$2,934.05
|
| Rate for Payer: First Health Commercial |
$3,358.25
|
| Rate for Payer: Humana Commercial |
$3,004.75
|
| Rate for Payer: Humana KY Medicaid |
$1,215.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,228.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,240.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,651.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,828.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,075.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,439.15
|
| Rate for Payer: PHCS Commercial |
$3,393.60
|
| Rate for Payer: United Healthcare All Payer |
$3,110.80
|
|
|
PARTIAL HIP REPLACEMENT(P
|
Professional
|
Both
|
$3,535.00
|
|
|
Service Code
|
HCPCS 27125
|
| Hospital Charge Code |
761P0780
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$914.33 |
| Max. Negotiated Rate |
$2,121.00 |
| Rate for Payer: Aetna Commercial |
$1,675.50
|
| Rate for Payer: Ambetter Exchange |
$1,075.22
|
| Rate for Payer: Anthem Medicaid |
$914.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,075.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,290.26
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cash Price |
$1,767.50
|
| Rate for Payer: Cigna Commercial |
$1,799.42
|
| Rate for Payer: Healthspan PPO |
$1,517.64
|
| Rate for Payer: Humana Medicaid |
$914.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,416.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,075.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,075.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$932.62
|
| Rate for Payer: Molina Healthcare Passport |
$914.33
|
| Rate for Payer: Multiplan PHCS |
$2,121.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,397.79
|
| Rate for Payer: UHCCP Medicaid |
$1,237.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$923.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,075.22
|
|
|
PARTIAL HYSTERECTOMY
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 58180
|
| Hospital Charge Code |
76102212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Humana KY Medicaid |
$773.77
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
PARTIAL HYSTERECTOMY
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 58180
|
| Hospital Charge Code |
76102212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,957.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
PARTIAL HYSTERECTOMY
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 58180
|
| Hospital Charge Code |
76102212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.91 |
| Max. Negotiated Rate |
$1,435.92 |
| Rate for Payer: Aetna Commercial |
$1,435.92
|
| Rate for Payer: Ambetter Exchange |
$912.48
|
| Rate for Payer: Anthem Medicaid |
$578.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$912.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$912.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,094.98
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,400.05
|
| Rate for Payer: Healthspan PPO |
$1,390.33
|
| Rate for Payer: Humana Medicaid |
$578.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,243.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$912.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$590.49
|
| Rate for Payer: Molina Healthcare Passport |
$578.91
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,186.22
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$912.48
|
|
|
PARTIAL HYSTERECTOMY(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 58180
|
| Hospital Charge Code |
761P2212
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$578.91 |
| Max. Negotiated Rate |
$1,435.92 |
| Rate for Payer: Aetna Commercial |
$1,435.92
|
| Rate for Payer: Ambetter Exchange |
$912.48
|
| Rate for Payer: Anthem Medicaid |
$578.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$912.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$912.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,094.98
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,400.05
|
| Rate for Payer: Healthspan PPO |
$1,390.33
|
| Rate for Payer: Humana Medicaid |
$578.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,243.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$912.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$590.49
|
| Rate for Payer: Molina Healthcare Passport |
$578.91
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,186.22
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$584.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$912.48
|
|
|
PARTIAL MASTECTOMY
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 19301
|
| Hospital Charge Code |
76100300
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.70 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Aetna Commercial |
$870.65
|
| Rate for Payer: Ambetter Exchange |
$628.72
|
| Rate for Payer: Anthem Medicaid |
$281.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$628.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$628.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.46
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$556.11
|
| Rate for Payer: Healthspan PPO |
$696.17
|
| Rate for Payer: Humana Medicaid |
$281.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$813.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$628.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$287.33
|
| Rate for Payer: Molina Healthcare Passport |
$281.70
|
| Rate for Payer: Multiplan PHCS |
$882.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$817.34
|
| Rate for Payer: UHCCP Medicaid |
$514.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$284.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$628.72
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 26235
|
| Hospital Charge Code |
76102833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.39 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Anthem Medicaid |
$175.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$484.50
|
| Rate for Payer: Humana Commercial |
$433.50
|
| Rate for Payer: Humana KY Medicaid |
$175.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$177.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.80
|
| Rate for Payer: Ohio Health Group HMO |
$382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.90
|
| Rate for Payer: PHCS Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Payer |
$448.80
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 26235
|
| Hospital Charge Code |
76102833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$784.99 |
| Rate for Payer: Aetna Commercial |
$709.90
|
| Rate for Payer: Ambetter Exchange |
$472.22
|
| Rate for Payer: Anthem Medicaid |
$299.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$472.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$472.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$566.66
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$784.99
|
| Rate for Payer: Healthspan PPO |
$643.02
|
| Rate for Payer: Humana Medicaid |
$299.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$605.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$472.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.88
|
| Rate for Payer: Molina Healthcare Passport |
$299.88
|
| Rate for Payer: Multiplan PHCS |
$306.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$613.89
|
| Rate for Payer: UHCCP Medicaid |
$178.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$472.22
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
76100684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 26235
|
| Hospital Charge Code |
76102833
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.80
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$484.50
|
| Rate for Payer: Humana Commercial |
$433.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.80
|
| Rate for Payer: Ohio Health Group HMO |
$382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.90
|
| Rate for Payer: PHCS Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Payer |
$448.80
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
76100684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
PARTIAL REMOVAL FINGER BONE
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
76100684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.82 |
| Max. Negotiated Rate |
$694.66 |
| Rate for Payer: Aetna Commercial |
$627.23
|
| Rate for Payer: Ambetter Exchange |
$423.78
|
| Rate for Payer: Anthem Medicaid |
$264.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$423.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$423.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$508.54
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$694.66
|
| Rate for Payer: Healthspan PPO |
$568.14
|
| Rate for Payer: Humana Medicaid |
$264.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$423.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$270.12
|
| Rate for Payer: Molina Healthcare Passport |
$264.82
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$550.91
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$267.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$423.78
|
|
|
PARTIAL REMOVAL FINGER BONE(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 26236
|
| Hospital Charge Code |
761P0684
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.82 |
| Max. Negotiated Rate |
$694.66 |
| Rate for Payer: Aetna Commercial |
$627.23
|
| Rate for Payer: Ambetter Exchange |
$423.78
|
| Rate for Payer: Anthem Medicaid |
$264.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$423.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$423.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$508.54
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$694.66
|
| Rate for Payer: Healthspan PPO |
$568.14
|
| Rate for Payer: Humana Medicaid |
$264.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$538.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$423.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$423.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$270.12
|
| Rate for Payer: Molina Healthcare Passport |
$264.82
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$550.91
|
| Rate for Payer: UHCCP Medicaid |
$332.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$267.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$423.78
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
OP
|
$6,046.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
76100972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,079.22 |
| Max. Negotiated Rate |
$5,804.16 |
| Rate for Payer: Aetna Commercial |
$4,655.42
|
| Rate for Payer: Anthem Medicaid |
$2,079.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,715.88
|
| 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 |
$3,023.00
|
| Rate for Payer: Cash Price |
$3,023.00
|
| Rate for Payer: Cigna Commercial |
$5,018.18
|
| Rate for Payer: First Health Commercial |
$5,743.70
|
| Rate for Payer: Humana Commercial |
$5,139.10
|
| Rate for Payer: Humana KY Medicaid |
$2,079.22
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,100.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,957.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,461.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,120.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,320.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,534.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,836.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,260.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,171.74
|
| Rate for Payer: PHCS Commercial |
$5,804.16
|
| Rate for Payer: United Healthcare All Payer |
$5,320.48
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Professional
|
Both
|
$6,046.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
76100972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.93 |
| Max. Negotiated Rate |
$3,627.60 |
| Rate for Payer: Aetna Commercial |
$548.42
|
| Rate for Payer: Ambetter Exchange |
$341.72
|
| 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 Individual/Medicaid |
$341.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$341.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$410.06
|
| Rate for Payer: Cash Price |
$3,023.00
|
| Rate for Payer: Cash Price |
$3,023.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$341.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.74
|
| Rate for Payer: Molina Healthcare Passport |
$274.25
|
| Rate for Payer: Multiplan PHCS |
$3,627.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.24
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$341.72
|
|
|
PARTIAL REMOVAL FOOT FASCIA
|
Facility
|
IP
|
$6,046.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
76100972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,813.80 |
| Max. Negotiated Rate |
$5,804.16 |
| Rate for Payer: Aetna Commercial |
$4,655.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,715.88
|
| Rate for Payer: Cash Price |
$3,023.00
|
| Rate for Payer: Cigna Commercial |
$5,018.18
|
| Rate for Payer: First Health Commercial |
$5,743.70
|
| Rate for Payer: Humana Commercial |
$5,139.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,957.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,461.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,813.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,320.48
|
| Rate for Payer: Ohio Health Group HMO |
$4,534.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,836.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,260.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,171.74
|
| Rate for Payer: PHCS Commercial |
$5,804.16
|
| Rate for Payer: United Healthcare All Payer |
$5,320.48
|
|
|
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 |
$640.26 |
| Rate for Payer: Aetna Commercial |
$548.42
|
| Rate for Payer: Ambetter Exchange |
$341.72
|
| 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 Individual/Medicaid |
$341.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$341.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$410.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$341.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.72
|
| 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 |
$444.24
|
| Rate for Payer: UHCCP Medicaid |
$193.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$341.72
|
|
|
PARTIAL REMOVAL FOOT FASCIA(T
|
Facility
|
IP
|
$5,146.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
761T0972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,543.80 |
| Max. Negotiated Rate |
$4,940.16 |
| Rate for Payer: Aetna Commercial |
$3,962.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.88
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cigna Commercial |
$4,271.18
|
| Rate for Payer: First Health Commercial |
$4,888.70
|
| Rate for Payer: Humana Commercial |
$4,374.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,543.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.74
|
| Rate for Payer: PHCS Commercial |
$4,940.16
|
| Rate for Payer: United Healthcare All Payer |
$4,528.48
|
|
|
PARTIAL REMOVAL FOOT FASCIA(T
|
Facility
|
OP
|
$5,146.00
|
|
|
Service Code
|
HCPCS 28060
|
| Hospital Charge Code |
761T0972
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,769.71 |
| Max. Negotiated Rate |
$4,940.16 |
| Rate for Payer: Aetna Commercial |
$3,962.42
|
| Rate for Payer: Anthem Medicaid |
$1,769.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,013.88
|
| 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 |
$2,573.00
|
| Rate for Payer: Cash Price |
$2,573.00
|
| Rate for Payer: Cigna Commercial |
$4,271.18
|
| Rate for Payer: First Health Commercial |
$4,888.70
|
| Rate for Payer: Humana Commercial |
$4,374.10
|
| Rate for Payer: Humana KY Medicaid |
$1,769.71
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,787.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,219.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,797.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,805.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,528.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,477.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,550.74
|
| Rate for Payer: PHCS Commercial |
$4,940.16
|
| Rate for Payer: United Healthcare All Payer |
$4,528.48
|
|
|
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 |
$1,465.80 |
| Rate for Payer: Aetna Commercial |
$1,245.36
|
| Rate for Payer: Ambetter Exchange |
$851.66
|
| Rate for Payer: Anthem Medicaid |
$534.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$851.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$851.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,021.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$851.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$851.66
|
| 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 |
$1,107.16
|
| Rate for Payer: UHCCP Medicaid |
$855.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$539.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$851.66
|
|
|
PARTIAL REMOVAL OF FIBULA
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
HCPCS 27641
|
| Hospital Charge Code |
76102884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$554.71 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,242.01
|
| Rate for Payer: Anthem Medicaid |
$554.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,258.14
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,290.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.97
|
| 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 |
$1,173.72 |
| Rate for Payer: Aetna Commercial |
$1,025.29
|
| Rate for Payer: Ambetter Exchange |
$625.02
|
| Rate for Payer: Anthem Medicaid |
$465.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$625.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$625.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$750.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$625.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.02
|
| 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 |
$812.53
|
| Rate for Payer: UHCCP Medicaid |
$564.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$625.02
|
|
