|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Hospital Charge Code |
76100977
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.70 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Anthem Medicaid |
$326.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$741.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$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
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
76100973
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.80 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$592.90
|
| Rate for Payer: Anthem Medicaid |
$264.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$600.60
|
| 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 |
$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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$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
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
76100974
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$153.00 |
| 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 |
$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(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 |
$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(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 |
$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(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: 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 FOREARM LESION
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
76100586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.50 |
| 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 |
$556.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.55
|
| Rate for Payer: PHCS Commercial |
$667.20
|
| Rate for Payer: United Healthcare All Payer |
$611.60
|
|
|
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: Ambetter Exchange |
$480.75
|
| Rate for Payer: Anthem Medicaid |
$370.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$480.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$576.90
|
| 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 |
$722.53
|
| Rate for Payer: Humana Medicaid |
$370.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$647.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$480.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.75
|
| 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 |
$624.98
|
| Rate for Payer: UHCCP Medicaid |
$243.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$480.75
|
|
|
REMOVAL OF FOREARM LESION
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS 25120
|
| Hospital Charge Code |
76100586
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.01 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$535.15
|
| Rate for Payer: Anthem Medicaid |
$239.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$542.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$556.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.55
|
| 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: Ambetter Exchange |
$480.75
|
| Rate for Payer: Anthem Medicaid |
$370.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$480.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$480.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$576.90
|
| 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 |
$722.53
|
| Rate for Payer: Humana Medicaid |
$370.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$647.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$480.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.75
|
| 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 |
$624.98
|
| Rate for Payer: UHCCP Medicaid |
$243.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$480.75
|
|
|
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 |
$458.50 |
| Rate for Payer: Anthem Medicaid |
$172.25
|
| 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 |
$172.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.69
|
| Rate for Payer: Molina Healthcare Passport |
$172.25
|
| 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 |
$173.97
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$6,322.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,174.14 |
| Max. Negotiated Rate |
$6,069.12 |
| Rate for Payer: Aetna Commercial |
$4,867.94
|
| Rate for Payer: Anthem Medicaid |
$2,174.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,931.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$3,161.00
|
| Rate for Payer: Cash Price |
$3,161.00
|
| Rate for Payer: Cigna Commercial |
$5,247.26
|
| Rate for Payer: First Health Commercial |
$6,005.90
|
| Rate for Payer: Humana Commercial |
$5,373.70
|
| Rate for Payer: Humana KY Medicaid |
$2,174.14
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,196.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,184.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,665.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,217.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,563.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,741.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,057.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,500.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.18
|
| Rate for Payer: PHCS Commercial |
$6,069.12
|
| Rate for Payer: United Healthcare All Payer |
$5,563.36
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$6,322.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,896.60 |
| Max. Negotiated Rate |
$6,069.12 |
| Rate for Payer: Aetna Commercial |
$4,867.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,931.16
|
| Rate for Payer: Cash Price |
$3,161.00
|
| Rate for Payer: Cigna Commercial |
$5,247.26
|
| Rate for Payer: First Health Commercial |
$6,005.90
|
| Rate for Payer: Humana Commercial |
$5,373.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,184.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,665.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,896.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,563.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,741.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,057.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,500.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.18
|
| Rate for Payer: PHCS Commercial |
$6,069.12
|
| Rate for Payer: United Healthcare All Payer |
$5,563.36
|
|
|
REMOVAL OF FOREIGN BODY
|
Professional
|
Both
|
$6,322.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
76100335
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.32 |
| Max. Negotiated Rate |
$3,793.20 |
| Rate for Payer: Aetna Commercial |
$364.70
|
| Rate for Payer: Ambetter Exchange |
$235.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$126.32
|
| Rate for Payer: Anthem Medicaid |
$162.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$235.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$282.64
|
| Rate for Payer: Cash Price |
$3,161.00
|
| Rate for Payer: Cash Price |
$3,161.00
|
| Rate for Payer: Cigna Commercial |
$400.67
|
| Rate for Payer: Healthspan PPO |
$583.41
|
| Rate for Payer: Humana Medicaid |
$162.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$308.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$235.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$165.86
|
| Rate for Payer: Molina Healthcare Passport |
$162.61
|
| Rate for Payer: Multiplan PHCS |
$3,793.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$306.19
|
| Rate for Payer: UHCCP Medicaid |
$132.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$164.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$235.53
|
|
|
REMOVAL OF FOREIGN BODY ARM
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
76100515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.12 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| 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 |
$2,644.48
|
| 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 |
$3,173.38
|
| 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 FOREIGN BODY ARM
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
76100515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.95 |
| Max. Negotiated Rate |
$687.43 |
| Rate for Payer: Aetna Commercial |
$523.96
|
| Rate for Payer: Ambetter Exchange |
$382.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.95
|
| Rate for Payer: Anthem Medicaid |
$220.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$459.31
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$578.67
|
| Rate for Payer: Healthspan PPO |
$687.43
|
| Rate for Payer: Humana Medicaid |
$220.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.56
|
| Rate for Payer: Molina Healthcare Passport |
$220.16
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.59
|
| Rate for Payer: UHCCP Medicaid |
$198.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.76
|
|
|
REMOVAL OF FOREIGN BODY ARM
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
76100515
|
|
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 FOREIGN BODY ARM(P
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 24201
|
| Hospital Charge Code |
761P0515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.95 |
| Max. Negotiated Rate |
$687.43 |
| Rate for Payer: Aetna Commercial |
$523.96
|
| Rate for Payer: Ambetter Exchange |
$382.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$188.95
|
| Rate for Payer: Anthem Medicaid |
$220.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$382.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$459.31
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$578.67
|
| Rate for Payer: Healthspan PPO |
$687.43
|
| Rate for Payer: Humana Medicaid |
$220.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$449.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$382.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$224.56
|
| Rate for Payer: Molina Healthcare Passport |
$220.16
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.59
|
| Rate for Payer: UHCCP Medicaid |
$198.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$222.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$382.76
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
45000328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem Medicaid |
$46.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Humana KY Medicaid |
$46.77
|
| Rate for Payer: Kentucky WC Medicaid |
$47.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
OP
|
$130.00
|
|
| Hospital Charge Code |
76102556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem Medicaid |
$44.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Humana KY Medicaid |
$44.71
|
| Rate for Payer: Kentucky WC Medicaid |
$45.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
45000328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$130.56 |
| Rate for Payer: Aetna Commercial |
$104.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$106.08
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cigna Commercial |
$112.88
|
| Rate for Payer: First Health Commercial |
$129.20
|
| Rate for Payer: Humana Commercial |
$115.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$111.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$100.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$119.68
|
| Rate for Payer: Ohio Health Group HMO |
$102.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$118.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.84
|
| Rate for Payer: PHCS Commercial |
$130.56
|
| Rate for Payer: United Healthcare All Payer |
$119.68
|
|
|
REMOVAL OF FOREIGN BODY/CORNEA
|
Facility
|
IP
|
$130.00
|
|
| Hospital Charge Code |
76102556
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$101.40
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$107.90
|
| Rate for Payer: First Health Commercial |
$123.50
|
| Rate for Payer: Humana Commercial |
$110.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$106.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$114.40
|
| Rate for Payer: Ohio Health Group HMO |
$97.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$113.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.70
|
| Rate for Payer: PHCS Commercial |
$124.80
|
| Rate for Payer: United Healthcare All Payer |
$114.40
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$2,095.90
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
OP
|
$3,702.27
|
|
|
Service Code
|
CPT 20525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,644.48 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
76101631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$387.23 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$867.02
|
| Rate for Payer: Anthem Medicaid |
$387.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$878.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cash Price |
$563.00
|
| Rate for Payer: Cigna Commercial |
$934.58
|
| Rate for Payer: First Health Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial |
$957.10
|
| Rate for Payer: Humana KY Medicaid |
$387.23
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$391.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$923.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.88
|
| Rate for Payer: Ohio Health Group HMO |
$844.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$900.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$776.94
|
| Rate for Payer: PHCS Commercial |
$1,080.96
|
| Rate for Payer: United Healthcare All Payer |
$990.88
|
|
