|
REMOVE WRIST/FOREARM LESION
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
76100584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$758.40 |
| Rate for Payer: Aetna Commercial |
$608.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.20
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$655.70
|
| Rate for Payer: First Health Commercial |
$750.50
|
| Rate for Payer: Humana Commercial |
$671.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$647.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.20
|
| Rate for Payer: Ohio Health Group HMO |
$592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.90
|
| Rate for Payer: PHCS Commercial |
$758.40
|
| Rate for Payer: United Healthcare All Payer |
$695.20
|
|
|
REMOVE WRIST/FOREARM LESION
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
76100584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,270.40 |
| Rate for Payer: Aetna Commercial |
$933.21
|
| Rate for Payer: Anthem Medicaid |
$441.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$790.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$1,270.40
|
| Rate for Payer: Healthspan PPO |
$845.29
|
| Rate for Payer: Humana Medicaid |
$441.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$450.47
|
| Rate for Payer: Molina Healthcare Passport |
$441.64
|
| Rate for Payer: Multiplan PHCS |
$474.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$553.00
|
| Rate for Payer: UHCCP Medicaid |
$276.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$446.06
|
|
|
REMOVE WRIST/FOREARM LESION(P
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 25116
|
| Hospital Charge Code |
761P0584
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,270.40 |
| Rate for Payer: Aetna Commercial |
$933.21
|
| Rate for Payer: Anthem Medicaid |
$441.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$790.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cash Price |
$395.00
|
| Rate for Payer: Cigna Commercial |
$1,270.40
|
| Rate for Payer: Healthspan PPO |
$845.29
|
| Rate for Payer: Humana Medicaid |
$441.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.87
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$450.47
|
| Rate for Payer: Molina Healthcare Passport |
$441.64
|
| Rate for Payer: Multiplan PHCS |
$474.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$553.00
|
| Rate for Payer: UHCCP Medicaid |
$276.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$446.06
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
76100580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.08 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$875.41
|
| Rate for Payer: Anthem Medicaid |
$336.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,016.37
|
| Rate for Payer: Healthspan PPO |
$792.93
|
| Rate for Payer: Humana Medicaid |
$336.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.80
|
| Rate for Payer: Molina Healthcare Passport |
$336.08
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.44
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
76100580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| 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 |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Humana KY Medicaid |
$524.45
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$529.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE WRIST JOINT CARTILAGE
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
76100580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$1,464.00 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,265.75
|
| Rate for Payer: First Health Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial |
$1,296.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,250.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,125.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$472.75
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE WRIST JOINT CARTILAG(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 25107
|
| Hospital Charge Code |
761P0580
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.08 |
| Max. Negotiated Rate |
$1,525.00 |
| Rate for Payer: Aetna Commercial |
$875.41
|
| Rate for Payer: Anthem Medicaid |
$336.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,525.00
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$1,016.37
|
| Rate for Payer: Healthspan PPO |
$792.93
|
| Rate for Payer: Humana Medicaid |
$336.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$758.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$342.80
|
| Rate for Payer: Molina Healthcare Passport |
$336.08
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,067.50
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$339.44
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
76100616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$642.82 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,527.82
|
| Rate for Payer: Anthem Medicaid |
$642.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,672.58
|
| Rate for Payer: Healthspan PPO |
$1,383.88
|
| Rate for Payer: Humana Medicaid |
$642.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,302.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$655.68
|
| Rate for Payer: Molina Healthcare Passport |
$642.82
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$649.25
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
76100616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
REMOVE WRIST JOINT IMPLANT
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
76100616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$292.50 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,732.50
|
| Rate for Payer: Anthem Medicaid |
$773.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,755.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,867.50
|
| Rate for Payer: First Health Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial |
$1,912.50
|
| Rate for Payer: Humana KY Medicaid |
$773.78
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$781.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,845.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,660.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$789.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,980.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,687.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$292.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$697.50
|
| Rate for Payer: PHCS Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare All Payer |
$1,980.00
|
|
|
REMOVE WRIST JOINT IMPLANT(P
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
HCPCS 25449
|
| Hospital Charge Code |
761P0616
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$642.82 |
| Max. Negotiated Rate |
$2,250.00 |
| Rate for Payer: Aetna Commercial |
$1,527.82
|
| Rate for Payer: Anthem Medicaid |
$642.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,250.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cash Price |
$1,125.00
|
| Rate for Payer: Cigna Commercial |
$1,672.58
|
| Rate for Payer: Healthspan PPO |
$1,383.88
|
| Rate for Payer: Humana Medicaid |
$642.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,302.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$655.68
|
| Rate for Payer: Molina Healthcare Passport |
$642.82
|
| Rate for Payer: Multiplan PHCS |
$1,350.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,575.00
|
| Rate for Payer: UHCCP Medicaid |
$787.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$649.25
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
76100579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$1,195.20 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$373.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.95
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
REMOVE WRIST JOINT LINING
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
76100579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$161.85 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Anthem Medicaid |
$428.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$971.10
|
| 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 |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$1,033.35
|
| Rate for Payer: First Health Commercial |
$1,182.75
|
| Rate for Payer: Humana Commercial |
$1,058.25
|
| Rate for Payer: Humana KY Medicaid |
$428.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$432.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,020.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$918.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$436.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,095.60
|
| Rate for Payer: Ohio Health Group HMO |
$933.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$249.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$161.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.95
|
| Rate for Payer: PHCS Commercial |
$1,195.20
|
| Rate for Payer: United Healthcare All Payer |
$1,095.60
|
|
|
REMOVE WRIST JOINT LINING
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
76100579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.77 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$707.98
|
| Rate for Payer: Anthem Medicaid |
$382.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$846.62
|
| Rate for Payer: Healthspan PPO |
$641.28
|
| Rate for Payer: Humana Medicaid |
$382.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$598.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.43
|
| Rate for Payer: Molina Healthcare Passport |
$382.77
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.60
|
|
|
REMOVE WRIST JOINT LINING(P
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 25105
|
| Hospital Charge Code |
761P0579
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.77 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$707.98
|
| Rate for Payer: Anthem Medicaid |
$382.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,245.00
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cash Price |
$622.50
|
| Rate for Payer: Cigna Commercial |
$846.62
|
| Rate for Payer: Healthspan PPO |
$641.28
|
| Rate for Payer: Humana Medicaid |
$382.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$598.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$390.43
|
| Rate for Payer: Molina Healthcare Passport |
$382.77
|
| Rate for Payer: Multiplan PHCS |
$747.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$871.50
|
| Rate for Payer: UHCCP Medicaid |
$435.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$386.60
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
76100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REMOVE WRIST TENDON LESION
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
76100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$514.65
|
| Rate for Payer: Anthem Medicaid |
$197.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$689.35
|
| Rate for Payer: Healthspan PPO |
$466.16
|
| Rate for Payer: Humana Medicaid |
$197.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$428.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.44
|
| Rate for Payer: Molina Healthcare Passport |
$197.49
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.46
|
|
|
REMOVE WRIST TENDON LESION
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
76100581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| 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 |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
REMOVE WRIST TENDON LESION(P
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 25110
|
| Hospital Charge Code |
761P0581
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$514.65
|
| Rate for Payer: Anthem Medicaid |
$197.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$840.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$689.35
|
| Rate for Payer: Healthspan PPO |
$466.16
|
| Rate for Payer: Humana Medicaid |
$197.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$428.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.44
|
| Rate for Payer: Molina Healthcare Passport |
$197.49
|
| Rate for Payer: Multiplan PHCS |
$504.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$588.00
|
| Rate for Payer: UHCCP Medicaid |
$294.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.46
|
|
|
REMOV FOREIGN BODY
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
76102411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$3,580.80 |
| Rate for Payer: Aetna Commercial |
$2,872.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.40
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cigna Commercial |
$3,095.90
|
| Rate for Payer: First Health Commercial |
$3,543.50
|
| Rate for Payer: Humana Commercial |
$3,170.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.30
|
| Rate for Payer: PHCS Commercial |
$3,580.80
|
| Rate for Payer: United Healthcare All Payer |
$3,282.40
|
|
|
REMOV FOREIGN BODY
|
Professional
|
Both
|
$3,730.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
76102411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$3,730.00 |
| Rate for Payer: Aetna Commercial |
$144.36
|
| Rate for Payer: Anthem Medicaid |
$65.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,730.00
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Healthspan PPO |
$128.06
|
| Rate for Payer: Humana Medicaid |
$65.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$129.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.42
|
| Rate for Payer: Molina Healthcare Passport |
$65.12
|
| Rate for Payer: Multiplan PHCS |
$2,238.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,611.00
|
| Rate for Payer: UHCCP Medicaid |
$1,305.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$65.77
|
|
|
REMOV FOREIGN BODY
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
76102411
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$484.90 |
| Max. Negotiated Rate |
$3,580.80 |
| Rate for Payer: Aetna Commercial |
$2,872.10
|
| Rate for Payer: Anthem Medicaid |
$1,282.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,909.40
|
| 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 |
$1,865.00
|
| Rate for Payer: Cash Price |
$1,865.00
|
| Rate for Payer: Cigna Commercial |
$3,095.90
|
| Rate for Payer: First Health Commercial |
$3,543.50
|
| Rate for Payer: Humana Commercial |
$3,170.50
|
| Rate for Payer: Humana KY Medicaid |
$1,282.75
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,058.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,752.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,282.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,797.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,156.30
|
| Rate for Payer: PHCS Commercial |
$3,580.80
|
| Rate for Payer: United Healthcare All Payer |
$3,282.40
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
76102410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$449.00 |
| Rate for Payer: Aetna Commercial |
$80.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$26.26
|
| Rate for Payer: Anthem Medicaid |
$29.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$449.00
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cash Price |
$224.50
|
| Rate for Payer: Cigna Commercial |
$174.85
|
| Rate for Payer: Healthspan PPO |
$147.20
|
| Rate for Payer: Humana Medicaid |
$29.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.78
|
| Rate for Payer: Molina Healthcare Passport |
$29.20
|
| Rate for Payer: Multiplan PHCS |
$269.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$314.30
|
| Rate for Payer: UHCCP Medicaid |
$27.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.49
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
761T2410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.72
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.94
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
REMOV FOREIGN BODY EXT AUDITOR
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
761T2410
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.62 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem Medicaid |
$94.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Humana KY Medicaid |
$94.23
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$95.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.94
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
