|
REMOVAL OF FOOT FOREIGN BOD(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
761P0990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$488.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.81
|
| Rate for Payer: Anthem Medicaid |
$189.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$542.02
|
| Rate for Payer: Healthspan PPO |
$587.57
|
| Rate for Payer: Humana Medicaid |
$189.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$392.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.69
|
| Rate for Payer: Molina Healthcare Passport |
$189.89
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.79
|
|
|
REMOVAL OF FOOT FOREIGN BOD(P
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
761P0991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.01 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$582.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$186.01
|
| Rate for Payer: Anthem Medicaid |
$230.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$945.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$635.11
|
| Rate for Payer: Healthspan PPO |
$676.58
|
| Rate for Payer: Humana Medicaid |
$230.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$462.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.36
|
| Rate for Payer: Molina Healthcare Passport |
$230.75
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$661.50
|
| Rate for Payer: UHCCP Medicaid |
$195.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.06
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76100990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$157.81 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$488.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$157.81
|
| Rate for Payer: Anthem Medicaid |
$189.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$542.02
|
| Rate for Payer: Healthspan PPO |
$587.57
|
| Rate for Payer: Humana Medicaid |
$189.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$392.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.69
|
| Rate for Payer: Molina Healthcare Passport |
$189.89
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.79
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76100991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$907.20 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$283.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76100991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.01 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Aetna Commercial |
$582.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$186.01
|
| Rate for Payer: Anthem Medicaid |
$230.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$945.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$635.11
|
| Rate for Payer: Healthspan PPO |
$676.58
|
| Rate for Payer: Humana Medicaid |
$230.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$462.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.36
|
| Rate for Payer: Molina Healthcare Passport |
$230.75
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$661.50
|
| Rate for Payer: UHCCP Medicaid |
$195.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.06
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76100990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76100990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76100991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.85 |
| Max. Negotiated Rate |
$1,962.83 |
| Rate for Payer: Aetna Commercial |
$727.65
|
| Rate for Payer: Anthem Medicaid |
$324.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$737.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$784.35
|
| Rate for Payer: First Health Commercial |
$897.75
|
| Rate for Payer: Humana Commercial |
$803.25
|
| Rate for Payer: Humana KY Medicaid |
$324.99
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$328.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$331.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$831.60
|
| Rate for Payer: Ohio Health Group HMO |
$708.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$292.95
|
| Rate for Payer: PHCS Commercial |
$907.20
|
| Rate for Payer: United Healthcare All Payer |
$831.60
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
76100977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Humana KY Medicaid |
$326.70
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$330.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$333.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
76100977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.61 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$537.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$179.61
|
| Rate for Payer: Anthem Medicaid |
$270.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$593.32
|
| Rate for Payer: Healthspan PPO |
$636.88
|
| Rate for Payer: Humana Medicaid |
$270.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$428.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.06
|
| Rate for Payer: Molina Healthcare Passport |
$270.65
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$188.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.36
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
76100973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$739.20 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$231.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
76100973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| 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 |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$639.10
|
| Rate for Payer: First Health Commercial |
$731.50
|
| Rate for Payer: Humana Commercial |
$654.50
|
| Rate for Payer: Humana KY Medicaid |
$264.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$267.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$631.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$568.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$270.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$677.60
|
| Rate for Payer: Ohio Health Group HMO |
$577.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$154.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.70
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
76100973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.55 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$515.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.55
|
| Rate for Payer: Anthem Medicaid |
$213.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$547.82
|
| Rate for Payer: Healthspan PPO |
$606.03
|
| Rate for Payer: Humana Medicaid |
$213.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.68
|
| Rate for Payer: Molina Healthcare Passport |
$213.41
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$201.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.54
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
76100977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.50 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$788.50
|
| Rate for Payer: First Health Commercial |
$902.50
|
| Rate for Payer: Humana Commercial |
$807.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$779.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$701.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$285.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$836.00
|
| Rate for Payer: Ohio Health Group HMO |
$712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
76100974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.80
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$484.50
|
| Rate for Payer: Humana Commercial |
$433.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.80
|
| Rate for Payer: Ohio Health Group HMO |
$382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.10
|
| Rate for Payer: PHCS Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Payer |
$448.80
|
|
|
REMOVAL OF FOOT LESION
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
76100974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$573.29 |
| Rate for Payer: Aetna Commercial |
$471.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$156.25
|
| Rate for Payer: Anthem Medicaid |
$213.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$510.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$517.38
|
| Rate for Payer: Healthspan PPO |
$573.29
|
| Rate for Payer: Humana Medicaid |
$213.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$381.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.31
|
| Rate for Payer: Molina Healthcare Passport |
$213.05
|
| Rate for Payer: Multiplan PHCS |
$306.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$357.00
|
| Rate for Payer: UHCCP Medicaid |
$164.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.18
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
76100974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.30 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Anthem Medicaid |
$175.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.80
|
| 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 |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$423.30
|
| Rate for Payer: First Health Commercial |
$484.50
|
| Rate for Payer: Humana Commercial |
$433.50
|
| Rate for Payer: Humana KY Medicaid |
$175.39
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$177.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$418.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$376.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$448.80
|
| Rate for Payer: Ohio Health Group HMO |
$382.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$102.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$66.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.10
|
| Rate for Payer: PHCS Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Payer |
$448.80
|
|
|
REMOVAL OF FOOT LESION(P
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
761P0974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$573.29 |
| Rate for Payer: Aetna Commercial |
$471.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$156.25
|
| Rate for Payer: Anthem Medicaid |
$213.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$510.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cash Price |
$255.00
|
| Rate for Payer: Cigna Commercial |
$517.38
|
| Rate for Payer: Healthspan PPO |
$573.29
|
| Rate for Payer: Humana Medicaid |
$213.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$381.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.31
|
| Rate for Payer: Molina Healthcare Passport |
$213.05
|
| Rate for Payer: Multiplan PHCS |
$306.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$357.00
|
| Rate for Payer: UHCCP Medicaid |
$164.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.18
|
|
|
REMOVAL OF FOOT LESION(P
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
761P0977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$179.61 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$537.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$179.61
|
| Rate for Payer: Anthem Medicaid |
$270.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cash Price |
$475.00
|
| Rate for Payer: Cigna Commercial |
$593.32
|
| Rate for Payer: Healthspan PPO |
$636.88
|
| Rate for Payer: Humana Medicaid |
$270.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$428.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$276.06
|
| Rate for Payer: Molina Healthcare Passport |
$270.65
|
| Rate for Payer: Multiplan PHCS |
$570.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$665.00
|
| Rate for Payer: UHCCP Medicaid |
$188.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.36
|
|
|
REMOVAL OF FOOT LESION(P
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
761P0973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.55 |
| Max. Negotiated Rate |
$770.00 |
| Rate for Payer: Aetna Commercial |
$515.99
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$191.55
|
| Rate for Payer: Anthem Medicaid |
$213.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$770.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna Commercial |
$547.82
|
| Rate for Payer: Healthspan PPO |
$606.03
|
| Rate for Payer: Humana Medicaid |
$213.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$440.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$217.68
|
| Rate for Payer: Molina Healthcare Passport |
$213.41
|
| Rate for Payer: Multiplan PHCS |
$462.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$539.00
|
| Rate for Payer: UHCCP Medicaid |
$201.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.54
|
|
|
REMOVAL OF FOREARM LESION
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
76100586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$1,121.98 |
| Rate for Payer: Aetna Commercial |
$797.69
|
| Rate for Payer: Anthem Medicaid |
$370.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$695.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$1,121.98
|
| Rate for Payer: Healthspan PPO |
$722.54
|
| Rate for Payer: Humana Medicaid |
$370.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$647.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.51
|
| Rate for Payer: Molina Healthcare Passport |
$370.11
|
| Rate for Payer: Multiplan PHCS |
$417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$486.50
|
| Rate for Payer: UHCCP Medicaid |
$243.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.81
|
|
|
REMOVAL OF FOREARM LESION
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
76100586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$667.20 |
| Rate for Payer: Aetna Commercial |
$535.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$542.10
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$576.85
|
| Rate for Payer: First Health Commercial |
$660.25
|
| Rate for Payer: Humana Commercial |
$590.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$611.60
|
| Rate for Payer: Ohio Health Group HMO |
$521.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.45
|
| Rate for Payer: PHCS Commercial |
$667.20
|
| Rate for Payer: United Healthcare All Payer |
$611.60
|
|
|
REMOVAL OF FOREARM LESION
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
76100586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.35 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$535.15
|
| Rate for Payer: Anthem Medicaid |
$239.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$542.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$576.85
|
| Rate for Payer: First Health Commercial |
$660.25
|
| Rate for Payer: Humana Commercial |
$590.75
|
| Rate for Payer: Humana KY Medicaid |
$239.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$241.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$569.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$512.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$243.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$611.60
|
| Rate for Payer: Ohio Health Group HMO |
$521.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.45
|
| Rate for Payer: PHCS Commercial |
$667.20
|
| Rate for Payer: United Healthcare All Payer |
$611.60
|
|
|
REMOVAL OF FOREARM LESION(P
|
Professional
|
Both
|
$695.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
761P0586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$1,121.98 |
| Rate for Payer: Aetna Commercial |
$797.69
|
| Rate for Payer: Anthem Medicaid |
$370.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$695.00
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cash Price |
$347.50
|
| Rate for Payer: Cigna Commercial |
$1,121.98
|
| Rate for Payer: Healthspan PPO |
$722.54
|
| Rate for Payer: Humana Medicaid |
$370.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$647.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.51
|
| Rate for Payer: Molina Healthcare Passport |
$370.11
|
| Rate for Payer: Multiplan PHCS |
$417.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$486.50
|
| Rate for Payer: UHCCP Medicaid |
$243.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.81
|
|
|
REMOVAL OF FOREHEAD OSTEOMA
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 21499
|
| Hospital Charge Code |
76102713
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$655.00 |
| Rate for Payer: Anthem Medicaid |
$132.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$655.00
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Cash Price |
$327.50
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$132.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$135.15
|
| Rate for Payer: Molina Healthcare Passport |
$132.50
|
| Rate for Payer: Multiplan PHCS |
$393.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$458.50
|
| Rate for Payer: UHCCP Medicaid |
$229.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$133.82
|
|
