|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
76102406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.39 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem Medicaid |
$316.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| 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 |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Humana KY Medicaid |
$316.39
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$319.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$322.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.80
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
REMOVE EXTERNAL EAR PARTIAL
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
76102406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.00 |
| Max. Negotiated Rate |
$883.20 |
| Rate for Payer: Aetna Commercial |
$708.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$717.60
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$763.60
|
| Rate for Payer: First Health Commercial |
$874.00
|
| Rate for Payer: Humana Commercial |
$782.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$754.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$678.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$809.60
|
| Rate for Payer: Ohio Health Group HMO |
$690.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$800.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$634.80
|
| Rate for Payer: PHCS Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Payer |
$809.60
|
|
|
REMOVE EXTERNAL EAR PARTIAL(P
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 69110
|
| Hospital Charge Code |
761P2406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.23 |
| Max. Negotiated Rate |
$555.09 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Ambetter Exchange |
$303.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$169.23
|
| Rate for Payer: Anthem Medicaid |
$177.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$303.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$303.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$364.43
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cigna Commercial |
$457.11
|
| Rate for Payer: Healthspan PPO |
$555.09
|
| Rate for Payer: Humana Medicaid |
$177.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$416.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$303.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$303.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$181.09
|
| Rate for Payer: Molina Healthcare Passport |
$177.54
|
| Rate for Payer: Multiplan PHCS |
$552.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$394.80
|
| Rate for Payer: UHCCP Medicaid |
$177.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$179.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$303.69
|
|
|
REMOVE EYELID LESION
|
Facility
|
OP
|
$3,130.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
76102391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$894.91 |
| Max. Negotiated Rate |
$3,005.43 |
| Rate for Payer: Aetna Commercial |
$2,410.61
|
| Rate for Payer: Anthem Medicaid |
$1,076.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$894.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.91
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,252.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,208.13
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cigna Commercial |
$2,598.45
|
| Rate for Payer: First Health Commercial |
$2,974.13
|
| Rate for Payer: Humana Commercial |
$2,661.06
|
| Rate for Payer: Humana KY Medicaid |
$1,076.63
|
| Rate for Payer: Humana Medicare Advantage |
$894.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,567.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,160.16
|
| Rate for Payer: PHCS Commercial |
$3,005.43
|
| Rate for Payer: United Healthcare All Payer |
$2,754.98
|
|
|
REMOVE EYELID LESION
|
Professional
|
Both
|
$3,130.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
76102391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$1,878.40 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Ambetter Exchange |
$144.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.33
|
| Rate for Payer: Anthem Medicaid |
$92.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.11
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Healthspan PPO |
$316.90
|
| Rate for Payer: Humana Medicaid |
$92.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$197.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.68
|
| Rate for Payer: Molina Healthcare Passport |
$92.82
|
| Rate for Payer: Multiplan PHCS |
$1,878.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.54
|
| Rate for Payer: UHCCP Medicaid |
$117.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.26
|
|
|
REMOVE EYELID LESION
|
Facility
|
IP
|
$3,130.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
76102391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$939.20 |
| Max. Negotiated Rate |
$3,005.43 |
| Rate for Payer: Aetna Commercial |
$2,410.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.91
|
| Rate for Payer: Cash Price |
$1,565.33
|
| Rate for Payer: Cigna Commercial |
$2,598.45
|
| Rate for Payer: First Health Commercial |
$2,974.13
|
| Rate for Payer: Humana Commercial |
$2,661.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,567.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,310.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,160.16
|
| Rate for Payer: PHCS Commercial |
$3,005.43
|
| Rate for Payer: United Healthcare All Payer |
$2,754.98
|
|
|
REMOVE EYELID LESION(P
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
761P2391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.82 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Ambetter Exchange |
$144.26
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$112.33
|
| Rate for Payer: Anthem Medicaid |
$92.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.11
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Healthspan PPO |
$316.90
|
| Rate for Payer: Humana Medicaid |
$92.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$197.53
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$94.68
|
| Rate for Payer: Molina Healthcare Passport |
$92.82
|
| Rate for Payer: Multiplan PHCS |
$405.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.54
|
| Rate for Payer: UHCCP Medicaid |
$117.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.26
|
|
|
REMOVE EYELID LESION(T
|
Facility
|
IP
|
$2,455.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
761T2391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$736.70 |
| Max. Negotiated Rate |
$2,357.43 |
| Rate for Payer: Aetna Commercial |
$1,890.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,915.41
|
| Rate for Payer: Cash Price |
$1,227.83
|
| Rate for Payer: Cigna Commercial |
$2,038.20
|
| Rate for Payer: First Health Commercial |
$2,332.88
|
| Rate for Payer: Humana Commercial |
$2,087.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,013.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,812.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$736.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,160.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,841.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,964.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,136.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.41
|
| Rate for Payer: PHCS Commercial |
$2,357.43
|
| Rate for Payer: United Healthcare All Payer |
$2,160.98
|
|
|
REMOVE EYELID LESION(T
|
Facility
|
OP
|
$2,455.66
|
|
|
Service Code
|
HCPCS 67840
|
| Hospital Charge Code |
761T2391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$844.50 |
| Max. Negotiated Rate |
$2,357.43 |
| Rate for Payer: Aetna Commercial |
$1,890.86
|
| Rate for Payer: Anthem Medicaid |
$844.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$894.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,915.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,252.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,208.13
|
| Rate for Payer: Cash Price |
$1,227.83
|
| Rate for Payer: Cash Price |
$1,227.83
|
| Rate for Payer: Cigna Commercial |
$2,038.20
|
| Rate for Payer: First Health Commercial |
$2,332.88
|
| Rate for Payer: Humana Commercial |
$2,087.31
|
| Rate for Payer: Humana KY Medicaid |
$844.50
|
| Rate for Payer: Humana Medicare Advantage |
$894.91
|
| Rate for Payer: Kentucky WC Medicaid |
$853.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,013.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,812.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$861.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,160.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,841.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,964.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,136.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,694.41
|
| Rate for Payer: PHCS Commercial |
$2,357.43
|
| Rate for Payer: United Healthcare All Payer |
$2,160.98
|
|
|
REMOVE FEMUR LESION
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
76100824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$457.50 |
| 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 |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE FEMUR LESION
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
76100824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.36 |
| Max. Negotiated Rate |
$966.71 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Ambetter Exchange |
$582.91
|
| Rate for Payer: Anthem Medicaid |
$440.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$582.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$582.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$699.49
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$966.71
|
| Rate for Payer: Healthspan PPO |
$796.77
|
| Rate for Payer: Humana Medicaid |
$440.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$582.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$449.17
|
| Rate for Payer: Molina Healthcare Passport |
$440.36
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$757.78
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$582.91
|
|
|
REMOVE FEMUR LESION
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
76100824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$524.45 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,174.25
|
| Rate for Payer: Anthem Medicaid |
$524.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,189.50
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$1,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,052.25
|
| Rate for Payer: PHCS Commercial |
$1,464.00
|
| Rate for Payer: United Healthcare All Payer |
$1,342.00
|
|
|
REMOVE FEMUR LESION/BURSA
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
76100771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.55 |
| Max. Negotiated Rate |
$714.09 |
| Rate for Payer: Aetna Commercial |
$651.45
|
| Rate for Payer: Ambetter Exchange |
$432.97
|
| Rate for Payer: Anthem Medicaid |
$269.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$432.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$432.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$519.56
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$714.09
|
| Rate for Payer: Healthspan PPO |
$590.08
|
| Rate for Payer: Humana Medicaid |
$269.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$558.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$274.94
|
| Rate for Payer: Molina Healthcare Passport |
$269.55
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$562.86
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$432.97
|
|
|
REMOVE FEMUR LESION/BURSA
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
76100771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.47 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| 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 |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE FEMUR LESION/BURSA
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
76100771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$259.50 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$752.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.85
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
REMOVE FEMUR LESION/BURSA(P
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 27062
|
| Hospital Charge Code |
761P0771
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$269.55 |
| Max. Negotiated Rate |
$714.09 |
| Rate for Payer: Aetna Commercial |
$651.45
|
| Rate for Payer: Ambetter Exchange |
$432.97
|
| Rate for Payer: Anthem Medicaid |
$269.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$432.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$432.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$519.56
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$714.09
|
| Rate for Payer: Healthspan PPO |
$590.08
|
| Rate for Payer: Humana Medicaid |
$269.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$558.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$274.94
|
| Rate for Payer: Molina Healthcare Passport |
$269.55
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$562.86
|
| Rate for Payer: UHCCP Medicaid |
$302.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$272.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$432.97
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
76100825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,311.82 |
| Rate for Payer: Aetna Commercial |
$1,203.83
|
| Rate for Payer: Ambetter Exchange |
$777.40
|
| Rate for Payer: Anthem Medicaid |
$553.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$932.88
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$1,311.82
|
| Rate for Payer: Healthspan PPO |
$1,090.41
|
| Rate for Payer: Humana Medicaid |
$553.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$777.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.43
|
| Rate for Payer: Molina Healthcare Passport |
$553.36
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,010.62
|
| Rate for Payer: UHCCP Medicaid |
$355.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.40
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
76100825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.50 |
| Max. Negotiated Rate |
$974.40 |
| Rate for Payer: Aetna Commercial |
$781.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.70
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$842.45
|
| Rate for Payer: First Health Commercial |
$964.25
|
| Rate for Payer: Humana Commercial |
$862.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$832.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$749.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$893.20
|
| Rate for Payer: Ohio Health Group HMO |
$761.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.35
|
| Rate for Payer: PHCS Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Payer |
$893.20
|
|
|
REMOVE FEMUR LESION/GRAFT
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
76100825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$349.06 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$781.55
|
| Rate for Payer: Anthem Medicaid |
$349.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$791.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$842.45
|
| Rate for Payer: First Health Commercial |
$964.25
|
| Rate for Payer: Humana Commercial |
$862.75
|
| Rate for Payer: Humana KY Medicaid |
$349.06
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$352.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$832.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$749.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$356.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$893.20
|
| Rate for Payer: Ohio Health Group HMO |
$761.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$812.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$883.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$700.35
|
| Rate for Payer: PHCS Commercial |
$974.40
|
| Rate for Payer: United Healthcare All Payer |
$893.20
|
|
|
REMOVE FEMUR LESION/GRAFT(P
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
HCPCS 27357
|
| Hospital Charge Code |
761P0825
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$355.25 |
| Max. Negotiated Rate |
$1,311.82 |
| Rate for Payer: Aetna Commercial |
$1,203.83
|
| Rate for Payer: Ambetter Exchange |
$777.40
|
| Rate for Payer: Anthem Medicaid |
$553.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$932.88
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cash Price |
$507.50
|
| Rate for Payer: Cigna Commercial |
$1,311.82
|
| Rate for Payer: Healthspan PPO |
$1,090.41
|
| Rate for Payer: Humana Medicaid |
$553.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,008.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$777.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$564.43
|
| Rate for Payer: Molina Healthcare Passport |
$553.36
|
| Rate for Payer: Multiplan PHCS |
$609.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,010.62
|
| Rate for Payer: UHCCP Medicaid |
$355.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$558.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.40
|
|
|
REMOVE FEMUR LESION(P
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 27355
|
| Hospital Charge Code |
761P0824
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$440.36 |
| Max. Negotiated Rate |
$966.71 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Ambetter Exchange |
$582.91
|
| Rate for Payer: Anthem Medicaid |
$440.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$582.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$582.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$699.49
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cash Price |
$762.50
|
| Rate for Payer: Cigna Commercial |
$966.71
|
| Rate for Payer: Healthspan PPO |
$796.77
|
| Rate for Payer: Humana Medicaid |
$440.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$582.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$449.17
|
| Rate for Payer: Molina Healthcare Passport |
$440.36
|
| Rate for Payer: Multiplan PHCS |
$915.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$757.78
|
| Rate for Payer: UHCCP Medicaid |
$533.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$444.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$582.91
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
76101994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$426.44 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem Medicaid |
$426.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Humana KY Medicaid |
$426.44
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Kentucky WC Medicaid |
$430.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$434.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
76101994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,190.40 |
| Rate for Payer: Aetna Commercial |
$954.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.20
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,029.20
|
| Rate for Payer: First Health Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial |
$1,054.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,016.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,091.20
|
| Rate for Payer: Ohio Health Group HMO |
$930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,078.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$855.60
|
| Rate for Payer: PHCS Commercial |
$1,190.40
|
| Rate for Payer: United Healthcare All Payer |
$1,091.20
|
|
|
REMOVE FOREIGN BODY ADBOMEN
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
76101994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$1,230.26 |
| Rate for Payer: Aetna Commercial |
$1,230.26
|
| Rate for Payer: Ambetter Exchange |
$816.94
|
| Rate for Payer: Anthem Medicaid |
$584.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$816.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$816.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$980.33
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,139.54
|
| Rate for Payer: Healthspan PPO |
$1,037.50
|
| Rate for Payer: Humana Medicaid |
$584.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,089.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$816.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.96
|
| Rate for Payer: Molina Healthcare Passport |
$584.27
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,062.02
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$816.94
|
|
|
REMOVE FOREIGN BODY ADBOMEN(P
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
HCPCS 49402
|
| Hospital Charge Code |
761P1994
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$434.00 |
| Max. Negotiated Rate |
$1,230.26 |
| Rate for Payer: Aetna Commercial |
$1,230.26
|
| Rate for Payer: Ambetter Exchange |
$816.94
|
| Rate for Payer: Anthem Medicaid |
$584.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$816.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$816.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$980.33
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cigna Commercial |
$1,139.54
|
| Rate for Payer: Healthspan PPO |
$1,037.50
|
| Rate for Payer: Humana Medicaid |
$584.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,089.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$816.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$816.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$595.96
|
| Rate for Payer: Molina Healthcare Passport |
$584.27
|
| Rate for Payer: Multiplan PHCS |
$744.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,062.02
|
| Rate for Payer: UHCCP Medicaid |
$434.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$590.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$816.94
|
|
