|
REMOVAL OF FINGER TENDON
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
76100680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.69 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$827.75
|
| Rate for Payer: Anthem Medicaid |
$369.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$838.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$373.45
|
| 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 |
$1,774.50
|
| 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 |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
REMOVAL OF FINGER TENDON
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26180
|
| Hospital Charge Code |
76100680
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.50 |
| 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 |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$935.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$741.75
|
| Rate for Payer: PHCS Commercial |
$1,032.00
|
| Rate for Payer: United Healthcare All Payer |
$946.00
|
|
|
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 |
$692.20 |
| Rate for Payer: Aetna Commercial |
$625.63
|
| Rate for Payer: Ambetter Exchange |
$432.15
|
| Rate for Payer: Anthem Medicaid |
$271.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$432.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$432.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$518.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$432.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.15
|
| 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 |
$561.79
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$432.15
|
|
|
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 |
$692.20 |
| Rate for Payer: Aetna Commercial |
$625.63
|
| Rate for Payer: Ambetter Exchange |
$432.15
|
| Rate for Payer: Anthem Medicaid |
$271.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$432.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$432.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$518.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$432.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.15
|
| 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 |
$561.79
|
| Rate for Payer: UHCCP Medicaid |
$376.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$274.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$432.15
|
|
|
REMOVAL OF FIXATION DEVICE
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
76100348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.30 |
| 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 |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| 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 |
$179.17 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| 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 |
$368.70
|
| 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 |
$442.44
|
| 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 |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| 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 |
$179.17 |
| Max. Negotiated Rate |
$516.18 |
| Rate for Payer: Aetna Commercial |
$401.17
|
| Rate for Payer: Anthem Medicaid |
$179.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$368.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$406.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$497.75
|
| 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 |
$368.70
|
| 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 |
$442.44
|
| 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 |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| 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 |
$156.30 |
| 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 |
$416.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$453.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.49
|
| 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: Ambetter Exchange |
$388.70
|
| 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 Individual/Medicaid |
$388.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$388.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$466.44
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$388.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$388.70
|
| 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 |
$505.31
|
| Rate for Payer: UHCCP Medicaid |
$240.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$397.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$388.70
|
|
|
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 |
$587.57 |
| Rate for Payer: Aetna Commercial |
$488.65
|
| Rate for Payer: Ambetter Exchange |
$295.60
|
| 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 Individual/Medicaid |
$295.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$354.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$295.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.60
|
| 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 |
$384.28
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$295.60
|
|
|
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 |
$676.58 |
| Rate for Payer: Aetna Commercial |
$582.11
|
| Rate for Payer: Ambetter Exchange |
$346.09
|
| 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 Individual/Medicaid |
$346.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.31
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$346.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.37
|
| Rate for Payer: Molina Healthcare Passport |
$230.75
|
| Rate for Payer: Multiplan PHCS |
$567.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$449.92
|
| Rate for Payer: UHCCP Medicaid |
$195.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.09
|
|
|
REMOVAL OF FOOT FOREIGN BOD(T
|
Facility
|
IP
|
$5,720.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
761T0991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,716.00 |
| Max. Negotiated Rate |
$5,491.20 |
| Rate for Payer: Aetna Commercial |
$4,404.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,461.60
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cigna Commercial |
$4,747.60
|
| Rate for Payer: First Health Commercial |
$5,434.00
|
| Rate for Payer: Humana Commercial |
$4,862.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,690.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,221.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,033.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,976.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,946.80
|
| Rate for Payer: PHCS Commercial |
$5,491.20
|
| Rate for Payer: United Healthcare All Payer |
$5,033.60
|
|
|
REMOVAL OF FOOT FOREIGN BOD(T
|
Facility
|
OP
|
$5,720.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
761T0991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,491.20 |
| Rate for Payer: Aetna Commercial |
$4,404.40
|
| Rate for Payer: Anthem Medicaid |
$1,967.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,461.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cigna Commercial |
$4,747.60
|
| Rate for Payer: First Health Commercial |
$5,434.00
|
| Rate for Payer: Humana Commercial |
$4,862.00
|
| Rate for Payer: Humana KY Medicaid |
$1,967.11
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,987.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,690.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,221.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,006.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,033.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,290.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,576.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,976.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,946.80
|
| Rate for Payer: PHCS Commercial |
$5,491.20
|
| Rate for Payer: United Healthcare All Payer |
$5,033.60
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76100990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.00 |
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$6,665.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76100991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,999.50 |
| Max. Negotiated Rate |
$6,398.40 |
| Rate for Payer: Aetna Commercial |
$5,132.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,198.70
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cigna Commercial |
$5,531.95
|
| Rate for Payer: First Health Commercial |
$6,331.75
|
| Rate for Payer: Humana Commercial |
$5,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,465.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,918.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,999.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,865.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,998.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,798.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,598.85
|
| Rate for Payer: PHCS Commercial |
$6,398.40
|
| Rate for Payer: United Healthcare All Payer |
$5,865.20
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$6,665.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76100991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.01 |
| Max. Negotiated Rate |
$3,999.00 |
| Rate for Payer: Aetna Commercial |
$582.11
|
| Rate for Payer: Ambetter Exchange |
$346.09
|
| 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 Individual/Medicaid |
$346.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$346.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.31
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cash Price |
$3,332.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$346.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$235.37
|
| Rate for Payer: Molina Healthcare Passport |
$230.75
|
| Rate for Payer: Multiplan PHCS |
$3,999.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$449.92
|
| Rate for Payer: UHCCP Medicaid |
$195.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$233.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$346.09
|
|
|
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 |
$587.57 |
| Rate for Payer: Aetna Commercial |
$488.65
|
| Rate for Payer: Ambetter Exchange |
$295.60
|
| 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 Individual/Medicaid |
$295.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$354.72
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$295.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.60
|
| 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 |
$384.28
|
| Rate for Payer: UHCCP Medicaid |
$165.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$295.60
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 28192
|
| Hospital Charge Code |
76100990
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| 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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$6,665.00
|
|
|
Service Code
|
HCPCS 28193
|
| Hospital Charge Code |
76100991
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$6,398.40 |
| Rate for Payer: Aetna Commercial |
$5,132.05
|
| Rate for Payer: Anthem Medicaid |
$2,292.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,198.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cash Price |
$3,332.50
|
| Rate for Payer: Cigna Commercial |
$5,531.95
|
| Rate for Payer: First Health Commercial |
$6,331.75
|
| Rate for Payer: Humana Commercial |
$5,665.25
|
| Rate for Payer: Humana KY Medicaid |
$2,292.09
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,315.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,465.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,918.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,338.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,865.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,998.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,798.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,598.85
|
| Rate for Payer: PHCS Commercial |
$6,398.40
|
| Rate for Payer: United Healthcare All Payer |
$5,865.20
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
76100973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| 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 |
$616.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.30
|
| Rate for Payer: PHCS Commercial |
$739.20
|
| Rate for Payer: United Healthcare All Payer |
$677.60
|
|
|
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 |
$636.88 |
| Rate for Payer: Aetna Commercial |
$537.75
|
| Rate for Payer: Ambetter Exchange |
$338.83
|
| 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 Individual/Medicaid |
$338.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$338.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$406.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$338.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.83
|
| 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 |
$440.48
|
| Rate for Payer: UHCCP Medicaid |
$188.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$273.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$338.83
|
|
|
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: Ambetter Exchange |
$293.50
|
| 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 Individual/Medicaid |
$293.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$293.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$352.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$293.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$293.50
|
| 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 |
$381.55
|
| Rate for Payer: UHCCP Medicaid |
$164.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$293.50
|
|
|
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 |
$606.03 |
| Rate for Payer: Aetna Commercial |
$515.99
|
| Rate for Payer: Ambetter Exchange |
$360.85
|
| 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 Individual/Medicaid |
$360.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$433.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$360.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.85
|
| 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 |
$469.11
|
| Rate for Payer: UHCCP Medicaid |
$201.13
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$215.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$360.85
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
76100974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.39 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$392.70
|
| Rate for Payer: Anthem Medicaid |
$175.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.90
|
| Rate for Payer: PHCS Commercial |
$489.60
|
| Rate for Payer: United Healthcare All Payer |
$448.80
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
76100977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.00 |
| 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 |
$760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$826.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.50
|
| Rate for Payer: PHCS Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Payer |
$836.00
|
|
