|
REVISION OF COLOSTOMY COMPLICA
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
76101841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
76101841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$449.75 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$1,505.65
|
| Rate for Payer: Anthem Medicaid |
$449.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,397.79
|
| Rate for Payer: Healthspan PPO |
$1,269.74
|
| Rate for Payer: Humana Medicaid |
$449.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.74
|
| Rate for Payer: Molina Healthcare Passport |
$449.75
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.25
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
76101841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.50 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
REVISION OF COLOSTOMY COMPLICA
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 44345
|
| Hospital Charge Code |
761P1841
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$449.75 |
| Max. Negotiated Rate |
$1,550.00 |
| Rate for Payer: Aetna Commercial |
$1,505.65
|
| Rate for Payer: Anthem Medicaid |
$449.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,550.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,397.79
|
| Rate for Payer: Healthspan PPO |
$1,269.74
|
| Rate for Payer: Humana Medicaid |
$449.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,337.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$458.74
|
| Rate for Payer: Molina Healthcare Passport |
$449.75
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,085.00
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$454.25
|
|
|
REVISION OF DIAPHRAGM
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
76101622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem Medicaid |
$378.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Humana KY Medicaid |
$378.29
|
| Rate for Payer: Kentucky WC Medicaid |
$382.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REVISION OF DIAPHRAGM
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
76101622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,401.81 |
| Rate for Payer: Aetna Commercial |
$1,361.77
|
| Rate for Payer: Anthem Medicaid |
$598.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,401.81
|
| Rate for Payer: Healthspan PPO |
$1,088.86
|
| Rate for Payer: Humana Medicaid |
$598.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,186.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$610.76
|
| Rate for Payer: Molina Healthcare Passport |
$598.78
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$604.77
|
|
|
REVISION OF DIAPHRAGM
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
76101622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$847.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$858.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$913.00
|
| Rate for Payer: First Health Commercial |
$1,045.00
|
| Rate for Payer: Humana Commercial |
$935.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$902.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$811.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$968.00
|
| Rate for Payer: Ohio Health Group HMO |
$825.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.00
|
| Rate for Payer: PHCS Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare All Payer |
$968.00
|
|
|
REVISION OF DIAPHRAGM(P
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 39545
|
| Hospital Charge Code |
761P1622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,401.81 |
| Rate for Payer: Aetna Commercial |
$1,361.77
|
| Rate for Payer: Anthem Medicaid |
$598.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,100.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cash Price |
$550.00
|
| Rate for Payer: Cigna Commercial |
$1,401.81
|
| Rate for Payer: Healthspan PPO |
$1,088.86
|
| Rate for Payer: Humana Medicaid |
$598.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,186.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$610.76
|
| Rate for Payer: Molina Healthcare Passport |
$598.78
|
| Rate for Payer: Multiplan PHCS |
$660.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$770.00
|
| Rate for Payer: UHCCP Medicaid |
$385.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$604.77
|
|
|
REVISION OF EYELID
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
76102399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.05 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna Commercial |
$617.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.05
|
| Rate for Payer: Anthem Medicaid |
$370.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,638.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$610.65
|
| Rate for Payer: Healthspan PPO |
$668.05
|
| Rate for Payer: Humana Medicaid |
$370.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.49
|
| Rate for Payer: Molina Healthcare Passport |
$370.09
|
| Rate for Payer: Multiplan PHCS |
$982.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,146.60
|
| Rate for Payer: UHCCP Medicaid |
$258.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.79
|
|
|
REVISION OF EYELID
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
76102400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.53 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.53
|
| Rate for Payer: Anthem Medicaid |
$362.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$594.13
|
| Rate for Payer: Healthspan PPO |
$665.68
|
| Rate for Payer: Humana Medicaid |
$362.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.19
|
| Rate for Payer: Molina Healthcare Passport |
$362.93
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$249.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.56
|
|
|
REVISION OF EYELID
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
76102400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REVISION OF EYELID
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
76102399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem Medicaid |
$563.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,277.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Humana KY Medicaid |
$563.31
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$569.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$574.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.78
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
REVISION OF EYELID
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
76102399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$212.94 |
| Max. Negotiated Rate |
$1,572.48 |
| Rate for Payer: Aetna Commercial |
$1,261.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,277.64
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$1,359.54
|
| Rate for Payer: First Health Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial |
$1,392.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,343.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,208.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$491.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,441.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,228.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$327.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.78
|
| Rate for Payer: PHCS Commercial |
$1,572.48
|
| Rate for Payer: United Healthcare All Payer |
$1,441.44
|
|
|
REVISION OF EYELID
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
76102400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
REVISION OF EYELID(P
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
HCPCS 67950
|
| Hospital Charge Code |
761P2399
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.05 |
| Max. Negotiated Rate |
$1,638.00 |
| Rate for Payer: Aetna Commercial |
$617.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$246.05
|
| Rate for Payer: Anthem Medicaid |
$370.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,638.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cash Price |
$819.00
|
| Rate for Payer: Cigna Commercial |
$610.65
|
| Rate for Payer: Healthspan PPO |
$668.05
|
| Rate for Payer: Humana Medicaid |
$370.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$585.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$377.49
|
| Rate for Payer: Molina Healthcare Passport |
$370.09
|
| Rate for Payer: Multiplan PHCS |
$982.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,146.60
|
| Rate for Payer: UHCCP Medicaid |
$258.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$373.79
|
|
|
REVISION OF EYELID(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 67961
|
| Hospital Charge Code |
761P2400
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.53 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$602.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.53
|
| Rate for Payer: Anthem Medicaid |
$362.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$594.13
|
| Rate for Payer: Healthspan PPO |
$665.68
|
| Rate for Payer: Humana Medicaid |
$362.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$574.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$370.19
|
| Rate for Payer: Molina Healthcare Passport |
$362.93
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$249.41
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$366.56
|
|
|
REVISION OF FOOT
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
76100983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.42 |
| Max. Negotiated Rate |
$1,088.64 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.54
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
REVISION OF FOOT
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
76100983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.42 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$941.22
|
| Rate for Payer: First Health Commercial |
$1,077.30
|
| Rate for Payer: Humana Commercial |
$963.90
|
| Rate for Payer: Humana KY Medicaid |
$389.98
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$393.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$929.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$836.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$997.92
|
| Rate for Payer: Ohio Health Group HMO |
$850.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.54
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
REVISION OF FOOT
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
76100983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.96
|
| Rate for Payer: Anthem Medicaid |
$341.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,134.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$929.84
|
| Rate for Payer: Healthspan PPO |
$946.44
|
| Rate for Payer: Humana Medicaid |
$341.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$706.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.72
|
| Rate for Payer: Molina Healthcare Passport |
$341.88
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.80
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.30
|
|
|
REVISION OF FOOT BONES
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 28737
|
| Hospital Charge Code |
76102774
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$1,158.75 |
| Rate for Payer: Aetna Commercial |
$1,067.57
|
| Rate for Payer: Anthem Medicaid |
$526.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cash Price |
$355.00
|
| Rate for Payer: Cigna Commercial |
$1,158.75
|
| Rate for Payer: Healthspan PPO |
$966.99
|
| Rate for Payer: Humana Medicaid |
$526.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$849.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$536.75
|
| Rate for Payer: Molina Healthcare Passport |
$526.23
|
| Rate for Payer: Multiplan PHCS |
$426.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$497.00
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.49
|
|
|
REVISION OF FOOT(P
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
761P0983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.96 |
| Max. Negotiated Rate |
$1,134.00 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$297.96
|
| Rate for Payer: Anthem Medicaid |
$341.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,134.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna Commercial |
$929.84
|
| Rate for Payer: Healthspan PPO |
$946.44
|
| Rate for Payer: Humana Medicaid |
$341.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$706.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$348.72
|
| Rate for Payer: Molina Healthcare Passport |
$341.88
|
| Rate for Payer: Multiplan PHCS |
$680.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$793.80
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.30
|
|
|
REVISION OF FOOT TENDON
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
76100997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.42 |
| Max. Negotiated Rate |
$866.17 |
| Rate for Payer: Aetna Commercial |
$770.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$263.42
|
| Rate for Payer: Anthem Medicaid |
$427.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$690.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$838.94
|
| Rate for Payer: Healthspan PPO |
$866.17
|
| Rate for Payer: Humana Medicaid |
$427.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.46
|
| Rate for Payer: Molina Healthcare Passport |
$427.90
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.00
|
| Rate for Payer: UHCCP Medicaid |
$276.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$432.18
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
76100997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
76100997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
REVISION OF FOOT TENDON(P
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
761P0997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.42 |
| Max. Negotiated Rate |
$866.17 |
| Rate for Payer: Aetna Commercial |
$770.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$263.42
|
| Rate for Payer: Anthem Medicaid |
$427.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$690.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$838.94
|
| Rate for Payer: Healthspan PPO |
$866.17
|
| Rate for Payer: Humana Medicaid |
$427.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$612.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$436.46
|
| Rate for Payer: Molina Healthcare Passport |
$427.90
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.00
|
| Rate for Payer: UHCCP Medicaid |
$276.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$432.18
|
|
