|
REMOVE/GRAFT FOREARM LESION
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25125
|
| Hospital Charge Code |
76100587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 25126
|
| Hospital Charge Code |
76100588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$1,284.06 |
| Rate for Payer: Aetna Commercial |
$942.40
|
| Rate for Payer: Ambetter Exchange |
$574.26
|
| Rate for Payer: Anthem Medicaid |
$418.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$574.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$574.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$689.11
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,284.06
|
| Rate for Payer: Healthspan PPO |
$853.62
|
| Rate for Payer: Humana Medicaid |
$418.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$574.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.20
|
| Rate for Payer: Molina Healthcare Passport |
$418.82
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$746.54
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$574.26
|
|
|
REMOVE/GRAFT FOREARM LESION
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25125
|
| Hospital Charge Code |
76100587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$415.90 |
| Max. Negotiated Rate |
$1,257.88 |
| Rate for Payer: Aetna Commercial |
$926.09
|
| Rate for Payer: Ambetter Exchange |
$570.48
|
| Rate for Payer: Anthem Medicaid |
$415.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$570.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$570.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$684.58
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,257.88
|
| Rate for Payer: Healthspan PPO |
$838.84
|
| Rate for Payer: Humana Medicaid |
$415.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$570.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$424.22
|
| Rate for Payer: Molina Healthcare Passport |
$415.90
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$741.62
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$420.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$570.48
|
|
|
REMOVE/GRAFT FOREARM LESION(P
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 25126
|
| Hospital Charge Code |
761P0588
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$1,284.06 |
| Rate for Payer: Aetna Commercial |
$942.40
|
| Rate for Payer: Ambetter Exchange |
$574.26
|
| Rate for Payer: Anthem Medicaid |
$418.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$574.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$574.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$689.11
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$1,284.06
|
| Rate for Payer: Healthspan PPO |
$853.62
|
| Rate for Payer: Humana Medicaid |
$418.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$770.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$574.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$427.20
|
| Rate for Payer: Molina Healthcare Passport |
$418.82
|
| Rate for Payer: Multiplan PHCS |
$477.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$746.54
|
| Rate for Payer: UHCCP Medicaid |
$278.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$423.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$574.26
|
|
|
REMOVE/GRAFT FOREARM LESION(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25125
|
| Hospital Charge Code |
761P0587
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$415.90 |
| Max. Negotiated Rate |
$1,257.88 |
| Rate for Payer: Aetna Commercial |
$926.09
|
| Rate for Payer: Ambetter Exchange |
$570.48
|
| Rate for Payer: Anthem Medicaid |
$415.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$570.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$570.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$684.58
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,257.88
|
| Rate for Payer: Healthspan PPO |
$838.84
|
| Rate for Payer: Humana Medicaid |
$415.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$767.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$570.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$424.22
|
| Rate for Payer: Molina Healthcare Passport |
$415.90
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$741.62
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$420.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$570.48
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
OP
|
$1,838.00
|
|
|
Service Code
|
HCPCS 27638
|
| Hospital Charge Code |
76102917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$632.09 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,415.26
|
| Rate for Payer: Anthem Medicaid |
$632.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,433.64
|
| 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 |
$919.00
|
| Rate for Payer: Cash Price |
$919.00
|
| Rate for Payer: Cigna Commercial |
$1,525.54
|
| Rate for Payer: First Health Commercial |
$1,746.10
|
| Rate for Payer: Humana Commercial |
$1,562.30
|
| Rate for Payer: Humana KY Medicaid |
$632.09
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$638.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,507.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,356.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$644.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,617.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,378.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,470.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,599.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,268.22
|
| Rate for Payer: PHCS Commercial |
$1,764.48
|
| Rate for Payer: United Healthcare All Payer |
$1,617.44
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Professional
|
Both
|
$1,838.00
|
|
|
Service Code
|
HCPCS 27638
|
| Hospital Charge Code |
76102917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$572.56 |
| Max. Negotiated Rate |
$1,268.06 |
| Rate for Payer: Aetna Commercial |
$1,161.67
|
| Rate for Payer: Ambetter Exchange |
$710.12
|
| Rate for Payer: Anthem Medicaid |
$572.56
|
| Rate for Payer: Buckeye Individual/Medicaid |
$710.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$852.14
|
| Rate for Payer: Cash Price |
$919.00
|
| Rate for Payer: Cash Price |
$919.00
|
| Rate for Payer: Cigna Commercial |
$1,268.06
|
| Rate for Payer: Healthspan PPO |
$1,052.22
|
| Rate for Payer: Humana Medicaid |
$572.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$968.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$710.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$584.01
|
| Rate for Payer: Molina Healthcare Passport |
$572.56
|
| Rate for Payer: Multiplan PHCS |
$1,102.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$923.16
|
| Rate for Payer: UHCCP Medicaid |
$643.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$578.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$710.12
|
|
|
REMOVE/GRAFT LEG BONE LESION
|
Facility
|
IP
|
$1,838.00
|
|
|
Service Code
|
HCPCS 27638
|
| Hospital Charge Code |
76102917
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$551.40 |
| Max. Negotiated Rate |
$1,764.48 |
| Rate for Payer: Aetna Commercial |
$1,415.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,433.64
|
| Rate for Payer: Cash Price |
$919.00
|
| Rate for Payer: Cigna Commercial |
$1,525.54
|
| Rate for Payer: First Health Commercial |
$1,746.10
|
| Rate for Payer: Humana Commercial |
$1,562.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,507.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,356.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,617.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,378.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,470.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,599.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,268.22
|
| Rate for Payer: PHCS Commercial |
$1,764.48
|
| Rate for Payer: United Healthcare All Payer |
$1,617.44
|
|
|
REMOVE HAND BONE LESION
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 26200
|
| Hospital Charge Code |
76100681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$348.60 |
| Max. Negotiated Rate |
$1,115.52 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$906.36
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$348.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.78
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
REMOVE HAND BONE LESION
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
HCPCS 26200
|
| Hospital Charge Code |
76100681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.71 |
| Max. Negotiated Rate |
$711.73 |
| Rate for Payer: Aetna Commercial |
$645.87
|
| Rate for Payer: Ambetter Exchange |
$432.07
|
| Rate for Payer: Anthem Medicaid |
$291.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$432.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$432.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$518.48
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$711.73
|
| Rate for Payer: Healthspan PPO |
$585.02
|
| Rate for Payer: Humana Medicaid |
$291.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$551.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$432.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.54
|
| Rate for Payer: Molina Healthcare Passport |
$291.71
|
| Rate for Payer: Multiplan PHCS |
$697.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$561.69
|
| Rate for Payer: UHCCP Medicaid |
$406.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$432.07
|
|
|
REMOVE HAND BONE LESION
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 26200
|
| Hospital Charge Code |
76100681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$399.61 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$894.74
|
| Rate for Payer: Anthem Medicaid |
$399.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$906.36
|
| 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 |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$964.46
|
| Rate for Payer: First Health Commercial |
$1,103.90
|
| Rate for Payer: Humana Commercial |
$987.70
|
| Rate for Payer: Humana KY Medicaid |
$399.61
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$403.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$952.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$857.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$407.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,022.56
|
| Rate for Payer: Ohio Health Group HMO |
$871.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$929.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,010.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$801.78
|
| Rate for Payer: PHCS Commercial |
$1,115.52
|
| Rate for Payer: United Healthcare All Payer |
$1,022.56
|
|
|
REMOVE HAND BONE LESION(P
|
Professional
|
Both
|
$1,162.00
|
|
|
Service Code
|
HCPCS 26200
|
| Hospital Charge Code |
761P0681
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.71 |
| Max. Negotiated Rate |
$711.73 |
| Rate for Payer: Aetna Commercial |
$645.87
|
| Rate for Payer: Ambetter Exchange |
$432.07
|
| Rate for Payer: Anthem Medicaid |
$291.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$432.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$432.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$518.48
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cash Price |
$581.00
|
| Rate for Payer: Cigna Commercial |
$711.73
|
| Rate for Payer: Healthspan PPO |
$585.02
|
| Rate for Payer: Humana Medicaid |
$291.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$551.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$432.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.54
|
| Rate for Payer: Molina Healthcare Passport |
$291.71
|
| Rate for Payer: Multiplan PHCS |
$697.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$561.69
|
| Rate for Payer: UHCCP Medicaid |
$406.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$432.07
|
|
|
REMOVE HIP FOREIGN BODY
|
Facility
|
IP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
76100773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$450.00 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REMOVE HIP FOREIGN BODY
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
76100773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.72 |
| Max. Negotiated Rate |
$1,009.31 |
| Rate for Payer: Aetna Commercial |
$926.51
|
| Rate for Payer: Ambetter Exchange |
$588.86
|
| Rate for Payer: Anthem Medicaid |
$346.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$588.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$588.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$706.63
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,009.31
|
| Rate for Payer: Healthspan PPO |
$839.22
|
| Rate for Payer: Humana Medicaid |
$346.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$780.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$588.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.65
|
| Rate for Payer: Molina Healthcare Passport |
$346.72
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$765.52
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$588.86
|
|
|
REMOVE HIP FOREIGN BODY
|
Facility
|
OP
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
76100773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$515.85 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,155.00
|
| Rate for Payer: Anthem Medicaid |
$515.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.00
|
| 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 |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,245.00
|
| Rate for Payer: First Health Commercial |
$1,425.00
|
| Rate for Payer: Humana Commercial |
$1,275.00
|
| Rate for Payer: Humana KY Medicaid |
$515.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$521.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.00
|
| Rate for Payer: PHCS Commercial |
$1,440.00
|
| Rate for Payer: United Healthcare All Payer |
$1,320.00
|
|
|
REMOVE HIP FOREIGN BODY(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 27087
|
| Hospital Charge Code |
761P0773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.72 |
| Max. Negotiated Rate |
$1,009.31 |
| Rate for Payer: Aetna Commercial |
$926.51
|
| Rate for Payer: Ambetter Exchange |
$588.86
|
| Rate for Payer: Anthem Medicaid |
$346.72
|
| Rate for Payer: Buckeye Individual/Medicaid |
$588.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$588.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$706.63
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$1,009.31
|
| Rate for Payer: Healthspan PPO |
$839.22
|
| Rate for Payer: Humana Medicaid |
$346.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$780.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$588.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.65
|
| Rate for Payer: Molina Healthcare Passport |
$346.72
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$765.52
|
| Rate for Payer: UHCCP Medicaid |
$525.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$588.86
|
|
|
REMOVE HIP PRESSURE SORE
|
Professional
|
Both
|
$7,307.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.28 |
| Max. Negotiated Rate |
$4,384.44 |
| Rate for Payer: Aetna Commercial |
$994.27
|
| Rate for Payer: Ambetter Exchange |
$674.00
|
| Rate for Payer: Anthem Medicaid |
$353.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$674.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$674.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$808.80
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cigna Commercial |
$947.83
|
| Rate for Payer: Healthspan PPO |
$795.01
|
| Rate for Payer: Humana Medicaid |
$353.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$674.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.35
|
| Rate for Payer: Molina Healthcare Passport |
$353.28
|
| Rate for Payer: Multiplan PHCS |
$4,384.44
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$876.20
|
| Rate for Payer: UHCCP Medicaid |
$2,557.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$674.00
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
OP
|
$7,307.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,513.01 |
| Max. Negotiated Rate |
$7,015.10 |
| Rate for Payer: Aetna Commercial |
$5,626.70
|
| Rate for Payer: Anthem Medicaid |
$2,513.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.77
|
| 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 |
$3,653.70
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cigna Commercial |
$6,065.14
|
| Rate for Payer: First Health Commercial |
$6,942.03
|
| Rate for Payer: Humana Commercial |
$6,211.29
|
| Rate for Payer: Humana KY Medicaid |
$2,513.01
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,538.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,563.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,042.11
|
| Rate for Payer: PHCS Commercial |
$7,015.10
|
| Rate for Payer: United Healthcare All Payer |
$6,430.51
|
|
|
REMOVE HIP PRESSURE SORE
|
Facility
|
IP
|
$7,307.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
76100236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,192.22 |
| Max. Negotiated Rate |
$7,015.10 |
| Rate for Payer: Aetna Commercial |
$5,626.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,699.77
|
| Rate for Payer: Cash Price |
$3,653.70
|
| Rate for Payer: Cigna Commercial |
$6,065.14
|
| Rate for Payer: First Health Commercial |
$6,942.03
|
| Rate for Payer: Humana Commercial |
$6,211.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,992.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,392.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,192.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,430.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,480.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,845.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,357.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,042.11
|
| Rate for Payer: PHCS Commercial |
$7,015.10
|
| Rate for Payer: United Healthcare All Payer |
$6,430.51
|
|
|
REMOVE HIP PRESSURE SORE(P
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
761P0236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$353.28 |
| Max. Negotiated Rate |
$994.27 |
| Rate for Payer: Aetna Commercial |
$994.27
|
| Rate for Payer: Ambetter Exchange |
$674.00
|
| Rate for Payer: Anthem Medicaid |
$353.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$674.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$674.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$808.80
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$947.83
|
| Rate for Payer: Healthspan PPO |
$795.01
|
| Rate for Payer: Humana Medicaid |
$353.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$864.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$674.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$674.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$360.35
|
| Rate for Payer: Molina Healthcare Passport |
$353.28
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$876.20
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$356.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$674.00
|
|
|
REMOVE HIP PRESSURE SORE(T
|
Facility
|
IP
|
$5,657.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
761T0236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,697.22 |
| Max. Negotiated Rate |
$5,431.10 |
| Rate for Payer: Aetna Commercial |
$4,356.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,412.77
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cigna Commercial |
$4,695.64
|
| Rate for Payer: First Health Commercial |
$5,374.53
|
| Rate for Payer: Humana Commercial |
$4,808.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,697.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,978.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,921.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,903.61
|
| Rate for Payer: PHCS Commercial |
$5,431.10
|
| Rate for Payer: United Healthcare All Payer |
$4,978.51
|
|
|
REMOVE HIP PRESSURE SORE(T
|
Facility
|
OP
|
$5,657.40
|
|
|
Service Code
|
HCPCS 15940
|
| Hospital Charge Code |
761T0236
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,945.58 |
| Max. Negotiated Rate |
$5,431.10 |
| Rate for Payer: Aetna Commercial |
$4,356.20
|
| Rate for Payer: Anthem Medicaid |
$1,945.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,412.77
|
| 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 |
$2,828.70
|
| Rate for Payer: Cash Price |
$2,828.70
|
| Rate for Payer: Cigna Commercial |
$4,695.64
|
| Rate for Payer: First Health Commercial |
$5,374.53
|
| Rate for Payer: Humana Commercial |
$4,808.79
|
| Rate for Payer: Humana KY Medicaid |
$1,945.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,965.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,639.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,175.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,984.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,978.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,525.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,921.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,903.61
|
| Rate for Payer: PHCS Commercial |
$5,431.10
|
| Rate for Payer: United Healthcare All Payer |
$4,978.51
|
|
|
REMOVE HIP PRESSURE ULCER
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,555.80 |
| Max. Negotiated Rate |
$4,343.04 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem Medicaid |
$1,555.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Humana KY Medicaid |
$1,555.80
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,571.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,587.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.56
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
|
REMOVE HIP PRESSURE ULCER
|
Professional
|
Both
|
$4,524.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$681.75 |
| Max. Negotiated Rate |
$2,714.40 |
| Rate for Payer: Aetna Commercial |
$1,410.67
|
| Rate for Payer: Ambetter Exchange |
$961.47
|
| Rate for Payer: Anthem Medicaid |
$681.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$961.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$961.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,153.76
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$1,352.86
|
| Rate for Payer: Healthspan PPO |
$1,127.96
|
| Rate for Payer: Humana Medicaid |
$681.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,233.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$961.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$695.38
|
| Rate for Payer: Molina Healthcare Passport |
$681.75
|
| Rate for Payer: Multiplan PHCS |
$2,714.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,249.91
|
| Rate for Payer: UHCCP Medicaid |
$1,583.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$688.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$961.47
|
|
|
REMOVE HIP PRESSURE ULCER
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
HCPCS 15945
|
| Hospital Charge Code |
76100238
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,357.20 |
| Max. Negotiated Rate |
$4,343.04 |
| Rate for Payer: Aetna Commercial |
$3,483.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,528.72
|
| Rate for Payer: Cash Price |
$2,262.00
|
| Rate for Payer: Cigna Commercial |
$3,754.92
|
| Rate for Payer: First Health Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial |
$3,845.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,709.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,338.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,357.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,981.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,619.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,935.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,121.56
|
| Rate for Payer: PHCS Commercial |
$4,343.04
|
| Rate for Payer: United Healthcare All Payer |
$3,981.12
|
|
