|
REVISION OF FOOT
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
HCPCS 28116
|
| Hospital Charge Code |
76100983
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.98 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$873.18
|
| Rate for Payer: Anthem Medicaid |
$389.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$884.52
|
| 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 |
$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 |
$2,997.95
|
| 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 |
$3,597.54
|
| 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 |
$907.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$782.46
|
| Rate for Payer: PHCS Commercial |
$1,088.64
|
| Rate for Payer: United Healthcare All Payer |
$997.92
|
|
|
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: Ambetter Exchange |
$652.23
|
| Rate for Payer: Anthem Medicaid |
$526.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$652.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$652.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$782.68
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$652.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.23
|
| 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 |
$847.90
|
| Rate for Payer: UHCCP Medicaid |
$248.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$531.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$652.23
|
|
|
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 |
$946.44 |
| Rate for Payer: Aetna Commercial |
$867.20
|
| Rate for Payer: Ambetter Exchange |
$495.88
|
| 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 Individual/Medicaid |
$495.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$495.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$595.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$495.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.88
|
| 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 |
$644.64
|
| Rate for Payer: UHCCP Medicaid |
$312.86
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$345.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$495.88
|
|
|
REVISION OF FOOT TENDON
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 28238
|
| Hospital Charge Code |
76100997
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| 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 |
$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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| 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 |
$207.00 |
| 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 |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
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: Ambetter Exchange |
$460.88
|
| 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 Individual/Medicaid |
$460.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$553.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$460.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.88
|
| 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 |
$599.14
|
| Rate for Payer: UHCCP Medicaid |
$276.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$432.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$460.88
|
|
|
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: Ambetter Exchange |
$460.88
|
| 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 Individual/Medicaid |
$460.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$460.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$553.06
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$460.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.88
|
| 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 |
$599.14
|
| Rate for Payer: UHCCP Medicaid |
$276.59
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$432.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$460.88
|
|
|
REVISION OF ILEOSTOMY
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 44314
|
| Hospital Charge Code |
76102773
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,454.92 |
| Rate for Payer: Aetna Commercial |
$1,454.92
|
| Rate for Payer: Ambetter Exchange |
$950.02
|
| Rate for Payer: Anthem Medicaid |
$495.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$950.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$950.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,140.02
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cigna Commercial |
$1,346.83
|
| Rate for Payer: Healthspan PPO |
$1,226.96
|
| Rate for Payer: Humana Medicaid |
$495.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,284.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$950.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$505.17
|
| Rate for Payer: Molina Healthcare Passport |
$495.26
|
| Rate for Payer: Multiplan PHCS |
$624.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,235.03
|
| Rate for Payer: UHCCP Medicaid |
$364.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$500.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$950.02
|
|
|
REVISION OF KNEE JOINT
|
Professional
|
Both
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
76100848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.39 |
| Max. Negotiated Rate |
$4,266.00 |
| Rate for Payer: Aetna Commercial |
$1,678.70
|
| Rate for Payer: Ambetter Exchange |
$1,090.55
|
| Rate for Payer: Anthem Medicaid |
$1,051.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,090.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,090.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,308.66
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$1,829.63
|
| Rate for Payer: Healthspan PPO |
$1,520.54
|
| Rate for Payer: Humana Medicaid |
$1,051.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,389.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,090.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,072.42
|
| Rate for Payer: Molina Healthcare Passport |
$1,051.39
|
| Rate for Payer: Multiplan PHCS |
$4,266.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,417.71
|
| Rate for Payer: UHCCP Medicaid |
$2,488.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,061.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,090.55
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
OP
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
76100848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,445.13 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Anthem Medicaid |
$2,445.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,545.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$5,901.30
|
| Rate for Payer: First Health Commercial |
$6,754.50
|
| Rate for Payer: Humana Commercial |
$6,043.50
|
| Rate for Payer: Humana KY Medicaid |
$2,445.13
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,470.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,494.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,256.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,185.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,905.90
|
| Rate for Payer: PHCS Commercial |
$6,825.60
|
| Rate for Payer: United Healthcare All Payer |
$6,256.80
|
|
|
REVISION OF KNEE JOINT
|
Facility
|
IP
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
76100848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,133.00 |
| Max. Negotiated Rate |
$6,825.60 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,545.80
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$5,901.30
|
| Rate for Payer: First Health Commercial |
$6,754.50
|
| Rate for Payer: Humana Commercial |
$6,043.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,830.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,247.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,133.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,256.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,688.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,185.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,905.90
|
| Rate for Payer: PHCS Commercial |
$6,825.60
|
| Rate for Payer: United Healthcare All Payer |
$6,256.80
|
|
|
REVISION OF KNEE JOINT(P
|
Professional
|
Both
|
$7,110.00
|
|
|
Service Code
|
HCPCS 27446
|
| Hospital Charge Code |
761P0848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,051.39 |
| Max. Negotiated Rate |
$4,266.00 |
| Rate for Payer: Aetna Commercial |
$1,678.70
|
| Rate for Payer: Ambetter Exchange |
$1,090.55
|
| Rate for Payer: Anthem Medicaid |
$1,051.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,090.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,090.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,308.66
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cash Price |
$3,555.00
|
| Rate for Payer: Cigna Commercial |
$1,829.63
|
| Rate for Payer: Healthspan PPO |
$1,520.54
|
| Rate for Payer: Humana Medicaid |
$1,051.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,389.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,090.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,072.42
|
| Rate for Payer: Molina Healthcare Passport |
$1,051.39
|
| Rate for Payer: Multiplan PHCS |
$4,266.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,417.71
|
| Rate for Payer: UHCCP Medicaid |
$2,488.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,061.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,090.55
|
|
|
REVISION OF LOWER LEG TENDON
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
76100912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$808.94 |
| Rate for Payer: Aetna Commercial |
$705.75
|
| Rate for Payer: Ambetter Exchange |
$442.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.92
|
| Rate for Payer: Anthem Medicaid |
$291.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$442.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$442.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$531.58
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$784.46
|
| Rate for Payer: Healthspan PPO |
$808.94
|
| Rate for Payer: Humana Medicaid |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$578.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$442.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.92
|
| Rate for Payer: Molina Healthcare Passport |
$291.10
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$575.87
|
| Rate for Payer: UHCCP Medicaid |
$249.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$442.98
|
|
|
REVISION OF LOWER LEG TENDON
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
76100912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem Medicaid |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| 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 |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Humana KY Medicaid |
$361.10
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$364.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$368.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REVISION OF LOWER LEG TENDON
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
76100912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$808.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$819.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$871.50
|
| Rate for Payer: First Health Commercial |
$997.50
|
| Rate for Payer: Humana Commercial |
$892.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$861.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$774.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$924.00
|
| Rate for Payer: Ohio Health Group HMO |
$787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$913.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$724.50
|
| Rate for Payer: PHCS Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare All Payer |
$924.00
|
|
|
REVISION OF LOWER LEG TENDO(P
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 27685
|
| Hospital Charge Code |
761P0912
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.92 |
| Max. Negotiated Rate |
$808.94 |
| Rate for Payer: Aetna Commercial |
$705.75
|
| Rate for Payer: Ambetter Exchange |
$442.98
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$237.92
|
| Rate for Payer: Anthem Medicaid |
$291.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$442.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$442.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$531.58
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cash Price |
$525.00
|
| Rate for Payer: Cigna Commercial |
$784.46
|
| Rate for Payer: Healthspan PPO |
$808.94
|
| Rate for Payer: Humana Medicaid |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$578.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$442.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$296.92
|
| Rate for Payer: Molina Healthcare Passport |
$291.10
|
| Rate for Payer: Multiplan PHCS |
$630.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$575.87
|
| Rate for Payer: UHCCP Medicaid |
$249.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$442.98
|
|
|
REVISION OF NOSE
|
Facility
|
IP
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
76102622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.50 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
REVISION OF NOSE
|
Facility
|
OP
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
76102622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.94 |
| Max. Negotiated Rate |
$4,195.14 |
| Rate for Payer: Aetna Commercial |
$481.25
|
| Rate for Payer: Anthem Medicaid |
$214.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$487.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$518.75
|
| Rate for Payer: First Health Commercial |
$593.75
|
| Rate for Payer: Humana Commercial |
$531.25
|
| Rate for Payer: Humana KY Medicaid |
$214.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$512.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$461.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$550.00
|
| Rate for Payer: Ohio Health Group HMO |
$468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$431.25
|
| Rate for Payer: PHCS Commercial |
$600.00
|
| Rate for Payer: United Healthcare All Payer |
$550.00
|
|
|
REVISION OF NOSE
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
761P2622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.86 |
| Max. Negotiated Rate |
$693.25 |
| Rate for Payer: Aetna Commercial |
$636.33
|
| Rate for Payer: Ambetter Exchange |
$394.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.86
|
| Rate for Payer: Anthem Medicaid |
$351.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$394.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$394.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.91
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$693.25
|
| Rate for Payer: Healthspan PPO |
$608.85
|
| Rate for Payer: Humana Medicaid |
$351.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.92
|
| Rate for Payer: Molina Healthcare Passport |
$351.88
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$512.32
|
| Rate for Payer: UHCCP Medicaid |
$237.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$394.09
|
|
|
REVISION OF NOSE
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 30120
|
| Hospital Charge Code |
76102622
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.86 |
| Max. Negotiated Rate |
$693.25 |
| Rate for Payer: Aetna Commercial |
$636.33
|
| Rate for Payer: Ambetter Exchange |
$394.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$225.86
|
| Rate for Payer: Anthem Medicaid |
$351.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$394.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$394.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$472.91
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cash Price |
$312.50
|
| Rate for Payer: Cigna Commercial |
$693.25
|
| Rate for Payer: Healthspan PPO |
$608.85
|
| Rate for Payer: Humana Medicaid |
$351.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$563.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.92
|
| Rate for Payer: Molina Healthcare Passport |
$351.88
|
| Rate for Payer: Multiplan PHCS |
$375.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$512.32
|
| Rate for Payer: UHCCP Medicaid |
$237.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$394.09
|
|
|
REVISION OF PENIS
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
HCPCS 54435
|
| Hospital Charge Code |
76102845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.88 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem Medicaid |
$147.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Humana KY Medicaid |
$147.88
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$149.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.70
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REVISION OF PENIS
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 54435
|
| Hospital Charge Code |
76102845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$673.83 |
| Rate for Payer: Aetna Commercial |
$673.83
|
| Rate for Payer: Ambetter Exchange |
$392.95
|
| Rate for Payer: Anthem Medicaid |
$285.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$392.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$392.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$471.54
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$598.75
|
| Rate for Payer: Healthspan PPO |
$652.44
|
| Rate for Payer: Humana Medicaid |
$285.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$567.04
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$392.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$392.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$291.71
|
| Rate for Payer: Molina Healthcare Passport |
$285.99
|
| Rate for Payer: Multiplan PHCS |
$258.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$510.83
|
| Rate for Payer: UHCCP Medicaid |
$150.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$288.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$392.95
|
|
|
REVISION OF PENIS
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
HCPCS 54435
|
| Hospital Charge Code |
76102845
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$412.80 |
| Rate for Payer: Aetna Commercial |
$331.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$335.40
|
| Rate for Payer: Cash Price |
$215.00
|
| Rate for Payer: Cigna Commercial |
$356.90
|
| Rate for Payer: First Health Commercial |
$408.50
|
| Rate for Payer: Humana Commercial |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$352.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$317.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$378.40
|
| Rate for Payer: Ohio Health Group HMO |
$322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.70
|
| Rate for Payer: PHCS Commercial |
$412.80
|
| Rate for Payer: United Healthcare All Payer |
$378.40
|
|
|
REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY
|
Facility
|
OP
|
$4,953.45
|
|
|
Service Code
|
CPT 19370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,538.18 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
|
|
REVISION OF PERITONEAL-VENOUS SHUNT
|
Facility
|
OP
|
$4,565.09
|
|
|
Service Code
|
CPT 49426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,260.78 |
| Max. Negotiated Rate |
$4,565.09 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,260.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,565.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,402.05
|
| Rate for Payer: Humana Medicare Advantage |
$3,260.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,912.94
|
|
