|
REMOVAL OF ESOPHAGUS
|
Professional
|
Both
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
76101720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,780.52 |
| Max. Negotiated Rate |
$7,830.00 |
| Rate for Payer: Aetna Commercial |
$6,343.12
|
| Rate for Payer: Anthem Medicaid |
$1,780.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,830.00
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$5,499.85
|
| Rate for Payer: Healthspan PPO |
$5,349.27
|
| Rate for Payer: Humana Medicaid |
$1,780.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,901.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,816.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,780.52
|
| Rate for Payer: Multiplan PHCS |
$4,698.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,481.00
|
| Rate for Payer: UHCCP Medicaid |
$2,740.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,798.33
|
|
|
REMOVAL OF ESOPHAGUS(P
|
Professional
|
Both
|
$2,805.00
|
|
|
Service Code
|
HCPCS 43107
|
| Hospital Charge Code |
761P1718
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$981.75 |
| Max. Negotiated Rate |
$3,850.15 |
| Rate for Payer: Aetna Commercial |
$3,850.15
|
| Rate for Payer: Anthem Medicaid |
$1,509.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,805.00
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cash Price |
$1,402.50
|
| Rate for Payer: Cigna Commercial |
$3,615.74
|
| Rate for Payer: Healthspan PPO |
$3,246.90
|
| Rate for Payer: Humana Medicaid |
$1,509.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,362.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,539.22
|
| Rate for Payer: Molina Healthcare Passport |
$1,509.04
|
| Rate for Payer: Multiplan PHCS |
$1,683.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,963.50
|
| Rate for Payer: UHCCP Medicaid |
$981.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,524.13
|
|
|
REMOVAL OF ESOPHAGUS(P
|
Professional
|
Both
|
$7,830.00
|
|
|
Service Code
|
HCPCS 43113
|
| Hospital Charge Code |
761P1720
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,780.52 |
| Max. Negotiated Rate |
$7,830.00 |
| Rate for Payer: Aetna Commercial |
$6,343.12
|
| Rate for Payer: Anthem Medicaid |
$1,780.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,830.00
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cash Price |
$3,915.00
|
| Rate for Payer: Cigna Commercial |
$5,499.85
|
| Rate for Payer: Healthspan PPO |
$5,349.27
|
| Rate for Payer: Humana Medicaid |
$1,780.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5,901.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,816.13
|
| Rate for Payer: Molina Healthcare Passport |
$1,780.52
|
| Rate for Payer: Multiplan PHCS |
$4,698.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,481.00
|
| Rate for Payer: UHCCP Medicaid |
$2,740.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,798.33
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
76101722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
76101722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$7,089.80 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,089.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,836.59
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$5,064.14
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,076.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
REMOVAL OF ESOPHAGUS POUCH
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
76101722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.75 |
| Max. Negotiated Rate |
$1,168.85 |
| Rate for Payer: Aetna Commercial |
$1,168.85
|
| Rate for Payer: Anthem Medicaid |
$634.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$985.00
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$1,120.01
|
| Rate for Payer: Healthspan PPO |
$985.72
|
| Rate for Payer: Humana Medicaid |
$634.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.85
|
| Rate for Payer: Molina Healthcare Passport |
$634.17
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.51
|
|
|
REMOVAL OF ESOPHAGUS POUCH(P
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 43130
|
| Hospital Charge Code |
761P1722
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$344.75 |
| Max. Negotiated Rate |
$1,168.85 |
| Rate for Payer: Aetna Commercial |
$1,168.85
|
| Rate for Payer: Anthem Medicaid |
$634.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$985.00
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$1,120.01
|
| Rate for Payer: Healthspan PPO |
$985.72
|
| Rate for Payer: Humana Medicaid |
$634.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,026.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$646.85
|
| Rate for Payer: Molina Healthcare Passport |
$634.17
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$640.51
|
|
|
REMOVAL OF EXTERNAL EAR
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 69120
|
| Hospital Charge Code |
76102749
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.53 |
| Max. Negotiated Rate |
$578.82 |
| Rate for Payer: Aetna Commercial |
$561.78
|
| Rate for Payer: Anthem Medicaid |
$138.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$410.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$578.82
|
| Rate for Payer: Healthspan PPO |
$498.32
|
| Rate for Payer: Humana Medicaid |
$138.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$510.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.30
|
| Rate for Payer: Molina Healthcare Passport |
$138.53
|
| Rate for Payer: Multiplan PHCS |
$246.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$287.00
|
| Rate for Payer: UHCCP Medicaid |
$143.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.92
|
|
|
REMOVAL OF FB FROM CERVIX
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Anthem Medicaid |
$570.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$325.00
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$570.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$581.40
|
| Rate for Payer: Molina Healthcare Passport |
$570.00
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$575.70
|
|
|
REMOVAL OF FB FROM CERVIX
|
Facility
|
IP
|
$325.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REMOVAL OF FB FROM CERVIX
|
Facility
|
OP
|
$325.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$250.25
|
| Rate for Payer: Anthem Medicaid |
$111.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$253.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cigna Commercial |
$269.75
|
| Rate for Payer: First Health Commercial |
$308.75
|
| Rate for Payer: Humana Commercial |
$276.25
|
| Rate for Payer: Humana KY Medicaid |
$111.77
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$112.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$266.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$286.00
|
| Rate for Payer: Ohio Health Group HMO |
$243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.75
|
| Rate for Payer: PHCS Commercial |
$312.00
|
| Rate for Payer: United Healthcare All Payer |
$286.00
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$1,428.66
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.47 |
| Max. Negotiated Rate |
$1,428.66 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,020.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,428.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,377.63
|
| Rate for Payer: Humana Medicare Advantage |
$1,020.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.56
|
|
|
REMOVAL OF FINGER LESION
|
Facility
|
IP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
76100682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$1,180.80 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$369.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.30
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
REMOVAL OF FINGER LESION
|
Facility
|
OP
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
76100682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$947.10
|
| Rate for Payer: Anthem Medicaid |
$423.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$1,020.90
|
| Rate for Payer: First Health Commercial |
$1,168.50
|
| Rate for Payer: Humana Commercial |
$1,045.50
|
| Rate for Payer: Humana KY Medicaid |
$423.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$427.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,008.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$907.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$431.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,082.40
|
| Rate for Payer: Ohio Health Group HMO |
$922.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$246.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$381.30
|
| Rate for Payer: PHCS Commercial |
$1,180.80
|
| Rate for Payer: United Healthcare All Payer |
$1,082.40
|
|
|
REMOVAL OF FINGER LESION
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
76100682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.99 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$623.01
|
| Rate for Payer: Anthem Medicaid |
$265.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,230.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$691.50
|
| Rate for Payer: Healthspan PPO |
$564.31
|
| Rate for Payer: Humana Medicaid |
$265.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.31
|
| Rate for Payer: Molina Healthcare Passport |
$265.99
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$861.00
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.65
|
|
|
REMOVAL OF FINGER LESION(P
|
Professional
|
Both
|
$1,230.00
|
|
|
Service Code
|
HCPCS 26210
|
| Hospital Charge Code |
761P0682
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$265.99 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$623.01
|
| Rate for Payer: Anthem Medicaid |
$265.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,230.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cash Price |
$615.00
|
| Rate for Payer: Cigna Commercial |
$691.50
|
| Rate for Payer: Healthspan PPO |
$564.31
|
| Rate for Payer: Humana Medicaid |
$265.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$537.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$271.31
|
| Rate for Payer: Molina Healthcare Passport |
$265.99
|
| Rate for Payer: Multiplan PHCS |
$738.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$861.00
|
| Rate for Payer: UHCCP Medicaid |
$430.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$268.65
|
|
|
REMOVAL OF FINGER TENDON
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
76100680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Aetna Commercial |
$625.63
|
| Rate for Payer: Anthem Medicaid |
$271.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$692.20
|
| Rate for Payer: Healthspan PPO |
$566.69
|
| Rate for Payer: Humana Medicaid |
$271.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$536.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.96
|
| Rate for Payer: Molina Healthcare Passport |
$271.53
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.25
|
|
|
REMOVAL OF FINGER TENDON
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
76100680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$322.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
REMOVAL OF FINGER TENDON
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
76100680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$892.25
|
| Rate for Payer: First Health Commercial |
$1,021.25
|
| Rate for Payer: Humana Commercial |
$913.75
|
| Rate for Payer: Humana KY Medicaid |
$369.69
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$373.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$881.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$793.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$946.00
|
| Rate for Payer: Ohio Health Group HMO |
$806.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.25
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
REMOVAL OF FINGER TENDON(P
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
761P0680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.53 |
| Max. Negotiated Rate |
$1,075.00 |
| Rate for Payer: Aetna Commercial |
$625.63
|
| Rate for Payer: Anthem Medicaid |
$271.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,075.00
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cash Price |
$537.50
|
| Rate for Payer: Cigna Commercial |
$692.20
|
| Rate for Payer: Healthspan PPO |
$566.69
|
| Rate for Payer: Humana Medicaid |
$271.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$536.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.96
|
| Rate for Payer: Molina Healthcare Passport |
$271.53
|
| Rate for Payer: Multiplan PHCS |
$645.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$752.50
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.25
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
76100348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
45000096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
76100348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.14
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Humana KY Medicaid |
$179.17
|
| Rate for Payer: Humana Medicare Advantage |
$344.55
|
| Rate for Payer: Kentucky WC Medicaid |
$181.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
45000096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$500.16 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cigna Commercial |
$432.43
|
| Rate for Payer: First Health Commercial |
$494.95
|
| Rate for Payer: Humana Commercial |
$442.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$427.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$384.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$458.48
|
| Rate for Payer: Ohio Health Group HMO |
$390.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$161.51
|
| Rate for Payer: PHCS Commercial |
$500.16
|
| Rate for Payer: United Healthcare All Payer |
$458.48
|
|
|
REMOVAL OF FOOT FASCIA
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
HCPCS 28062
|
| Hospital Charge Code |
76102746
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.89 |
| Max. Negotiated Rate |
$754.88 |
| Rate for Payer: Aetna Commercial |
$645.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.89
|
| Rate for Payer: Anthem Medicaid |
$393.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$580.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cigna Commercial |
$697.01
|
| Rate for Payer: Healthspan PPO |
$754.88
|
| Rate for Payer: Humana Medicaid |
$393.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$508.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$400.93
|
| Rate for Payer: Molina Healthcare Passport |
$393.07
|
| Rate for Payer: Multiplan PHCS |
$348.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$406.00
|
| Rate for Payer: UHCCP Medicaid |
$240.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$397.00
|
|
