|
PARTIAL REMOVAL OF RECTUM
|
Facility
|
OP
|
$1,305.00
|
|
|
Service Code
|
HCPCS 45111
|
| Hospital Charge Code |
76101878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$391.50 |
| Max. Negotiated Rate |
$1,252.80 |
| Rate for Payer: Aetna Commercial |
$1,004.85
|
| Rate for Payer: Anthem Medicaid |
$448.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,017.90
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna Commercial |
$1,083.15
|
| Rate for Payer: First Health Commercial |
$1,239.75
|
| Rate for Payer: Humana Commercial |
$1,109.25
|
| Rate for Payer: Humana KY Medicaid |
$448.79
|
| Rate for Payer: Kentucky WC Medicaid |
$453.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,070.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$963.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$391.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$457.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$978.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$900.45
|
| Rate for Payer: PHCS Commercial |
$1,252.80
|
| Rate for Payer: United Healthcare All Payer |
$1,148.40
|
|
|
PARTIAL REMOVAL OF RECTUM(P
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
HCPCS 45111
|
| Hospital Charge Code |
761P1878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$456.75 |
| Max. Negotiated Rate |
$1,568.16 |
| Rate for Payer: Aetna Commercial |
$1,568.16
|
| Rate for Payer: Ambetter Exchange |
$1,026.13
|
| Rate for Payer: Anthem Medicaid |
$815.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,026.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,026.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,231.36
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cash Price |
$652.50
|
| Rate for Payer: Cigna Commercial |
$1,460.43
|
| Rate for Payer: Healthspan PPO |
$1,322.46
|
| Rate for Payer: Humana Medicaid |
$815.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,386.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,026.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$831.78
|
| Rate for Payer: Molina Healthcare Passport |
$815.47
|
| Rate for Payer: Multiplan PHCS |
$783.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,333.97
|
| Rate for Payer: UHCCP Medicaid |
$456.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$823.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,026.13
|
|
|
PARTIAL REMOVAL OF THYROID
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 60225
|
| Hospital Charge Code |
76102274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.87 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna Commercial |
$1,351.14
|
| Rate for Payer: Ambetter Exchange |
$891.28
|
| Rate for Payer: Anthem Medicaid |
$669.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$891.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$891.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,069.54
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,269.82
|
| Rate for Payer: Healthspan PPO |
$1,139.44
|
| Rate for Payer: Humana Medicaid |
$669.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,189.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$891.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$683.27
|
| Rate for Payer: Molina Healthcare Passport |
$669.87
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,158.66
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$676.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$891.28
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 60225
|
| Hospital Charge Code |
76102274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$705.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
PARTIAL REMOVAL OF THYROID
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
HCPCS 60225
|
| Hospital Charge Code |
76102274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$808.16 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$1,809.50
|
| Rate for Payer: Anthem Medicaid |
$808.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,833.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,950.50
|
| Rate for Payer: First Health Commercial |
$2,232.50
|
| Rate for Payer: Humana Commercial |
$1,997.50
|
| Rate for Payer: Humana KY Medicaid |
$808.16
|
| Rate for Payer: Humana Medicare Advantage |
$5,390.83
|
| Rate for Payer: Kentucky WC Medicaid |
$816.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,927.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,734.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,469.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$824.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,068.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,762.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,880.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,044.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,621.50
|
| Rate for Payer: PHCS Commercial |
$2,256.00
|
| Rate for Payer: United Healthcare All Payer |
$2,068.00
|
|
|
PARTIAL REMOVAL OF THYROID(P
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 60225
|
| Hospital Charge Code |
761P2274
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$669.87 |
| Max. Negotiated Rate |
$1,410.00 |
| Rate for Payer: Aetna Commercial |
$1,351.14
|
| Rate for Payer: Ambetter Exchange |
$891.28
|
| Rate for Payer: Anthem Medicaid |
$669.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$891.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$891.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,069.54
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cash Price |
$1,175.00
|
| Rate for Payer: Cigna Commercial |
$1,269.82
|
| Rate for Payer: Healthspan PPO |
$1,139.44
|
| Rate for Payer: Humana Medicaid |
$669.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,189.70
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$891.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$891.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$683.27
|
| Rate for Payer: Molina Healthcare Passport |
$669.87
|
| Rate for Payer: Multiplan PHCS |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,158.66
|
| Rate for Payer: UHCCP Medicaid |
$822.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$676.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$891.28
|
|
|
PARTIAL REMOVAL OF TIBIA
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27640
|
| Hospital Charge Code |
76100904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.87 |
| Max. Negotiated Rate |
$1,457.48 |
| Rate for Payer: Aetna Commercial |
$1,281.55
|
| Rate for Payer: Ambetter Exchange |
$786.56
|
| Rate for Payer: Anthem Medicaid |
$600.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$786.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$786.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$943.87
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: Healthspan PPO |
$1,160.81
|
| Rate for Payer: Humana Medicaid |
$600.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,060.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$786.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$786.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.89
|
| Rate for Payer: Molina Healthcare Passport |
$600.87
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.53
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$786.56
|
|
|
PARTIAL REMOVAL OF TIBIA
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27640
|
| Hospital Charge Code |
76100904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
PARTIAL REMOVAL OF TIBIA
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27640
|
| Hospital Charge Code |
76100904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.61 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| 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 |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
PARTIAL REMOVAL OF TIBIA(P
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27640
|
| Hospital Charge Code |
761P0904
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.87 |
| Max. Negotiated Rate |
$1,457.48 |
| Rate for Payer: Aetna Commercial |
$1,281.55
|
| Rate for Payer: Ambetter Exchange |
$786.56
|
| Rate for Payer: Anthem Medicaid |
$600.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$786.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$786.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$943.87
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: Healthspan PPO |
$1,160.81
|
| Rate for Payer: Humana Medicaid |
$600.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,060.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$786.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$786.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$612.89
|
| Rate for Payer: Molina Healthcare Passport |
$600.87
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.53
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$606.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$786.56
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 28160
|
| Hospital Charge Code |
76102606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$509.50 |
| Rate for Payer: Aetna Commercial |
$414.77
|
| Rate for Payer: Ambetter Exchange |
$253.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.00
|
| Rate for Payer: Anthem Medicaid |
$225.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$253.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$253.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$304.45
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$461.56
|
| Rate for Payer: Healthspan PPO |
$509.50
|
| Rate for Payer: Humana Medicaid |
$225.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$253.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$229.58
|
| Rate for Payer: Molina Healthcare Passport |
$225.08
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.82
|
| Rate for Payer: UHCCP Medicaid |
$142.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$253.71
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS 28160
|
| Hospital Charge Code |
76102606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.63 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem Medicaid |
$161.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Humana KY Medicaid |
$161.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$163.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.30
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 28126
|
| Hospital Charge Code |
76103015
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$383.12
|
| Rate for Payer: Ambetter Exchange |
$236.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$125.80
|
| Rate for Payer: Anthem Medicaid |
$214.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$236.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$236.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$284.23
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cash Price |
$295.00
|
| Rate for Payer: Cigna Commercial |
$472.07
|
| Rate for Payer: Healthspan PPO |
$477.44
|
| Rate for Payer: Humana Medicaid |
$214.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$236.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.27
|
| Rate for Payer: Molina Healthcare Passport |
$214.97
|
| Rate for Payer: Multiplan PHCS |
$354.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$307.92
|
| Rate for Payer: UHCCP Medicaid |
$132.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$236.86
|
|
|
PARTIAL REMOVAL OF TOE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 28160
|
| Hospital Charge Code |
761P2606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$509.50 |
| Rate for Payer: Aetna Commercial |
$414.77
|
| Rate for Payer: Ambetter Exchange |
$253.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$136.00
|
| Rate for Payer: Anthem Medicaid |
$225.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$253.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$253.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$304.45
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$461.56
|
| Rate for Payer: Healthspan PPO |
$509.50
|
| Rate for Payer: Humana Medicaid |
$225.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$335.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$253.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$253.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$229.58
|
| Rate for Payer: Molina Healthcare Passport |
$225.08
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.82
|
| Rate for Payer: UHCCP Medicaid |
$142.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$227.33
|
| Rate for Payer: Wellcare Medicare Advantage |
$253.71
|
|
|
PARTIAL REMOVAL OF TOE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS 28160
|
| Hospital Charge Code |
76102606
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$366.60
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$390.10
|
| Rate for Payer: First Health Commercial |
$446.50
|
| Rate for Payer: Humana Commercial |
$399.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$385.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$413.60
|
| Rate for Payer: Ohio Health Group HMO |
$352.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.30
|
| Rate for Payer: PHCS Commercial |
$451.20
|
| Rate for Payer: United Healthcare All Payer |
$413.60
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
76100593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
OP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 25150
|
| Hospital Charge Code |
76100589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.86 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,058.75
|
| Rate for Payer: Anthem Medicaid |
$472.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,072.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$687.50
|
| 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: Humana KY Medicaid |
$472.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$477.68
|
| 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 |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.35
|
| 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 |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.75
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
IP
|
$1,375.00
|
|
|
Service Code
|
HCPCS 25150
|
| Hospital Charge Code |
76100589
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.50 |
| 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 |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.75
|
| Rate for Payer: PHCS Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare All Payer |
$1,210.00
|
|
|
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 |
$993.23 |
| Rate for Payer: Aetna Commercial |
$839.61
|
| Rate for Payer: Ambetter Exchange |
$544.13
|
| Rate for Payer: Anthem Medicaid |
$398.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$544.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$652.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$544.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.13
|
| 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 |
$707.37
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$544.13
|
|
|
PARTIAL REMOVAL OF ULNA
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 25240
|
| Hospital Charge Code |
76100593
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$343.90 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| 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 |
$500.00
|
| 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: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| 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 |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
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 |
$772.59 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: Ambetter Exchange |
$413.22
|
| Rate for Payer: Anthem Medicaid |
$307.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$413.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$413.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$495.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$413.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.22
|
| 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 |
$537.19
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$310.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$413.22
|
|
|
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 |
$772.59 |
| Rate for Payer: Aetna Commercial |
$635.17
|
| Rate for Payer: Ambetter Exchange |
$413.22
|
| Rate for Payer: Anthem Medicaid |
$307.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$413.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$413.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$495.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$413.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.22
|
| 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 |
$537.19
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$310.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$413.22
|
|
|
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 |
$993.23 |
| Rate for Payer: Aetna Commercial |
$839.61
|
| Rate for Payer: Ambetter Exchange |
$544.13
|
| Rate for Payer: Anthem Medicaid |
$398.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$544.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$544.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$652.96
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$544.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.13
|
| 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 |
$707.37
|
| Rate for Payer: UHCCP Medicaid |
$481.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$544.13
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 60212
|
| Hospital Charge Code |
76102272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$419.56 |
| Max. Negotiated Rate |
$7,547.16 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,390.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,547.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,277.62
|
| 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 |
$5,390.83
|
| 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 |
$6,469.00
|
| 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 |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
PARTIAL THYROID EXCISION
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS 60212
|
| Hospital Charge Code |
76102272
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$366.00 |
| 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 |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
