|
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: Ambetter Exchange |
$978.18
|
| Rate for Payer: Anthem Medicaid |
$738.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$978.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$978.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,173.82
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$978.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.18
|
| 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 |
$1,271.63
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$978.18
|
|
|
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: Ambetter Exchange |
$978.18
|
| Rate for Payer: Anthem Medicaid |
$738.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$978.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$978.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,173.82
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$978.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.18
|
| 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 |
$1,271.63
|
| Rate for Payer: UHCCP Medicaid |
$427.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$746.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$978.18
|
|
|
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 |
$888.00 |
| Rate for Payer: Aetna Commercial |
$597.70
|
| Rate for Payer: Ambetter Exchange |
$469.60
|
| 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 Individual/Medicaid |
$469.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$563.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$469.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.60
|
| 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 |
$610.48
|
| Rate for Payer: UHCCP Medicaid |
$266.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$469.60
|
|
|
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 |
$444.00 |
| 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 |
$1,184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,287.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.20
|
| 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 |
$508.97 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,139.60
|
| Rate for Payer: Anthem Medicaid |
$508.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,154.40
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,287.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,021.20
|
| Rate for Payer: PHCS Commercial |
$1,420.80
|
| Rate for Payer: United Healthcare All Payer |
$1,302.40
|
|
|
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 |
$888.00 |
| Rate for Payer: Aetna Commercial |
$597.70
|
| Rate for Payer: Ambetter Exchange |
$469.60
|
| 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 Individual/Medicaid |
$469.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$469.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$563.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$469.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.60
|
| 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 |
$610.48
|
| Rate for Payer: UHCCP Medicaid |
$266.53
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$295.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$469.60
|
|
|
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: Ambetter Exchange |
$405.69
|
| 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 Individual/Medicaid |
$405.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$405.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$486.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$405.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.69
|
| 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 |
$527.40
|
| Rate for Payer: UHCCP Medicaid |
$226.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$405.69
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 28113
|
| Hospital Charge Code |
76100982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.94 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 28113
|
| Hospital Charge Code |
76100982
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.50 |
| 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 |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
76100979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| 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 |
$558.61 |
| Rate for Payer: Aetna Commercial |
$441.17
|
| Rate for Payer: Ambetter Exchange |
$280.39
|
| 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 Individual/Medicaid |
$280.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$336.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.39
|
| 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 |
$364.51
|
| Rate for Payer: UHCCP Medicaid |
$155.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$280.39
|
|
|
PART REMOVAL OF METATARSAL
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 28110
|
| Hospital Charge Code |
76100979
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
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 |
$558.61 |
| Rate for Payer: Aetna Commercial |
$441.17
|
| Rate for Payer: Ambetter Exchange |
$280.39
|
| 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 Individual/Medicaid |
$280.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$336.47
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$280.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.39
|
| 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 |
$364.51
|
| Rate for Payer: UHCCP Medicaid |
$155.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$280.39
|
|
|
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: Ambetter Exchange |
$405.69
|
| 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 Individual/Medicaid |
$405.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$405.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$486.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$405.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.69
|
| 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 |
$527.40
|
| Rate for Payer: UHCCP Medicaid |
$226.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$253.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$405.69
|
|
|
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 |
$474.00 |
| 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 |
$1,264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,374.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.20
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
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 |
$474.00 |
| 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 |
$1,264.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,374.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,090.20
|
| Rate for Payer: PHCS Commercial |
$1,516.80
|
| Rate for Payer: United Healthcare All Payer |
$1,390.40
|
|
|
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 |
$1,349.95 |
| Rate for Payer: Aetna Commercial |
$1,239.91
|
| Rate for Payer: Ambetter Exchange |
$826.88
|
| Rate for Payer: Anthem Medicaid |
$509.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$826.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$826.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$992.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$826.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$826.88
|
| 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 |
$1,074.94
|
| Rate for Payer: UHCCP Medicaid |
$553.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$826.88
|
|
|
PART REMOVE HIP BONE SUPER(P
|
Professional
|
Both
|
$1,580.00
|
|
|
Service Code
|
HCPCS 27070
|
| Hospital Charge Code |
761P0772
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.26 |
| Max. Negotiated Rate |
$1,349.95 |
| Rate for Payer: Aetna Commercial |
$1,239.91
|
| Rate for Payer: Ambetter Exchange |
$826.88
|
| Rate for Payer: Anthem Medicaid |
$509.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$826.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$826.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$992.26
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$826.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$826.88
|
| 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 |
$1,074.94
|
| Rate for Payer: UHCCP Medicaid |
$553.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$514.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$826.88
|
|
|
PATADAY 0.1% 100DROP/5ML
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 65427401
|
| Hospital Charge Code |
25003900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Anthem Medicaid |
$0.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.68
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.72
|
| Rate for Payer: First Health Commercial |
$0.83
|
| Rate for Payer: Humana Commercial |
$0.74
|
| Rate for Payer: Humana KY Medicaid |
$0.30
|
| Rate for Payer: Kentucky WC Medicaid |
$0.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
PATADAY 0.1% 100DROP/5ML
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 65427401
|
| Hospital Charge Code |
25003900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.68
|
| Rate for Payer: Cash Price |
$0.44
|
| Rate for Payer: Cigna Commercial |
$0.72
|
| Rate for Payer: First Health Commercial |
$0.83
|
| Rate for Payer: Humana Commercial |
$0.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.77
|
| Rate for Payer: Ohio Health Group HMO |
$0.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.60
|
| Rate for Payer: PHCS Commercial |
$0.84
|
| Rate for Payer: United Healthcare All Payer |
$0.77
|
|
|
PATADAY EYE DROPS
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
NDC 536130723
|
| Hospital Charge Code |
25001158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.39
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna Commercial |
$1.48
|
| Rate for Payer: First Health Commercial |
$1.69
|
| Rate for Payer: Humana Commercial |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.57
|
| Rate for Payer: Ohio Health Group HMO |
$1.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.23
|
| Rate for Payer: PHCS Commercial |
$1.71
|
| Rate for Payer: United Healthcare All Payer |
$1.57
|
|
|
PATADAY EYE DROPS
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
NDC 536130723
|
| Hospital Charge Code |
25001158
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Anthem Medicaid |
$0.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1.39
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Cigna Commercial |
$1.48
|
| Rate for Payer: First Health Commercial |
$1.69
|
| Rate for Payer: Humana Commercial |
$1.51
|
| Rate for Payer: Humana KY Medicaid |
$0.61
|
| Rate for Payer: Kentucky WC Medicaid |
$0.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1.57
|
| Rate for Payer: Ohio Health Group HMO |
$1.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.23
|
| Rate for Payer: PHCS Commercial |
$1.71
|
| Rate for Payer: United Healthcare All Payer |
$1.57
|
|
|
PATCH BOVINE PERICARDIAL
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PATCH BOVINE PERICARDIAL
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PATCH CARDIOVASCULAR 3CM*6CM
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.50 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,874.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,486.95
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
