|
DECOMPRESSION OF LEG
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27894
|
| Hospital Charge Code |
76102944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
DECOMPRESSION OF LEG
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27894
|
| Hospital Charge Code |
76102944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$670.61 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| 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 |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
DECOMPRESSION OF LEG
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 27894
|
| Hospital Charge Code |
76102944
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.52 |
| Max. Negotiated Rate |
$1,329.32 |
| Rate for Payer: Aetna Commercial |
$1,249.23
|
| Rate for Payer: Ambetter Exchange |
$780.74
|
| Rate for Payer: Anthem Medicaid |
$351.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$780.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$780.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$936.89
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,329.32
|
| Rate for Payer: Healthspan PPO |
$1,131.54
|
| Rate for Payer: Humana Medicaid |
$351.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,082.68
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$780.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$358.55
|
| Rate for Payer: Molina Healthcare Passport |
$351.52
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,014.96
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$355.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$780.74
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
76100886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.36 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem Medicaid |
$261.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| 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 |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Humana KY Medicaid |
$261.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$264.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$266.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.40
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
OP
|
$4,683.73
|
|
|
Service Code
|
HCPCS 27601
|
| Hospital Charge Code |
76100884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,610.73 |
| Max. Negotiated Rate |
$4,496.38 |
| Rate for Payer: Aetna Commercial |
$3,606.47
|
| Rate for Payer: Anthem Medicaid |
$1,610.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,653.31
|
| 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 |
$2,341.86
|
| Rate for Payer: Cash Price |
$2,341.86
|
| Rate for Payer: Cigna Commercial |
$3,887.50
|
| Rate for Payer: First Health Commercial |
$4,449.54
|
| Rate for Payer: Humana Commercial |
$3,981.17
|
| Rate for Payer: Humana KY Medicaid |
$1,610.73
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,627.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,840.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,456.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,643.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,121.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,512.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,746.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,074.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,231.77
|
| Rate for Payer: PHCS Commercial |
$4,496.38
|
| Rate for Payer: United Healthcare All Payer |
$4,121.68
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
76100886
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$592.80
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cigna Commercial |
$630.80
|
| Rate for Payer: First Health Commercial |
$722.00
|
| Rate for Payer: Humana Commercial |
$646.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$623.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$560.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$668.80
|
| Rate for Payer: Ohio Health Group HMO |
$570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$524.40
|
| Rate for Payer: PHCS Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Payer |
$668.80
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
IP
|
$4,683.73
|
|
|
Service Code
|
HCPCS 27601
|
| Hospital Charge Code |
76100884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,405.12 |
| Max. Negotiated Rate |
$4,496.38 |
| Rate for Payer: Aetna Commercial |
$3,606.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,653.31
|
| Rate for Payer: Cash Price |
$2,341.86
|
| Rate for Payer: Cigna Commercial |
$3,887.50
|
| Rate for Payer: First Health Commercial |
$4,449.54
|
| Rate for Payer: Humana Commercial |
$3,981.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,840.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,456.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,121.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,512.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,746.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,074.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,231.77
|
| Rate for Payer: PHCS Commercial |
$4,496.38
|
| Rate for Payer: United Healthcare All Payer |
$4,121.68
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
IP
|
$7,302.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
76100885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,190.60 |
| Max. Negotiated Rate |
$7,009.92 |
| Rate for Payer: Aetna Commercial |
$5,622.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,695.56
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cigna Commercial |
$6,060.66
|
| Rate for Payer: First Health Commercial |
$6,936.90
|
| Rate for Payer: Humana Commercial |
$6,206.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,987.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,388.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,190.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,425.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,476.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,841.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,352.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,038.38
|
| Rate for Payer: PHCS Commercial |
$7,009.92
|
| Rate for Payer: United Healthcare All Payer |
$6,425.76
|
|
|
DECOMPRESSION OF LOWER LEG
|
Professional
|
Both
|
$7,302.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
76100885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.89 |
| Max. Negotiated Rate |
$4,381.20 |
| Rate for Payer: Aetna Commercial |
$767.98
|
| Rate for Payer: Ambetter Exchange |
$452.20
|
| Rate for Payer: Anthem Medicaid |
$321.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$452.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$452.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$542.64
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cigna Commercial |
$840.92
|
| Rate for Payer: Healthspan PPO |
$695.62
|
| Rate for Payer: Humana Medicaid |
$321.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$452.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.33
|
| Rate for Payer: Molina Healthcare Passport |
$321.89
|
| Rate for Payer: Multiplan PHCS |
$4,381.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$587.86
|
| Rate for Payer: UHCCP Medicaid |
$2,555.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$452.20
|
|
|
DECOMPRESSION OF LOWER LEG
|
Facility
|
OP
|
$7,302.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
76100885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,511.16 |
| Max. Negotiated Rate |
$7,009.92 |
| Rate for Payer: Aetna Commercial |
$5,622.54
|
| Rate for Payer: Anthem Medicaid |
$2,511.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,695.56
|
| 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 |
$3,651.00
|
| Rate for Payer: Cash Price |
$3,651.00
|
| Rate for Payer: Cigna Commercial |
$6,060.66
|
| Rate for Payer: First Health Commercial |
$6,936.90
|
| Rate for Payer: Humana Commercial |
$6,206.70
|
| Rate for Payer: Humana KY Medicaid |
$2,511.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,987.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,388.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,561.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,425.76
|
| Rate for Payer: Ohio Health Group HMO |
$5,476.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,841.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,352.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,038.38
|
| Rate for Payer: PHCS Commercial |
$7,009.92
|
| Rate for Payer: United Healthcare All Payer |
$6,425.76
|
|
|
DECOMPRESSION OF LOWER LEG
|
Professional
|
Both
|
$4,683.73
|
|
|
Service Code
|
HCPCS 27601
|
| Hospital Charge Code |
76100884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$253.07 |
| Max. Negotiated Rate |
$2,810.24 |
| Rate for Payer: Aetna Commercial |
$642.31
|
| Rate for Payer: Ambetter Exchange |
$416.23
|
| Rate for Payer: Anthem Medicaid |
$253.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$416.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$499.48
|
| Rate for Payer: Cash Price |
$2,341.86
|
| Rate for Payer: Cash Price |
$2,341.86
|
| Rate for Payer: Cigna Commercial |
$700.62
|
| Rate for Payer: Healthspan PPO |
$581.80
|
| Rate for Payer: Humana Medicaid |
$253.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$557.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.13
|
| Rate for Payer: Molina Healthcare Passport |
$253.07
|
| Rate for Payer: Multiplan PHCS |
$2,810.24
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.10
|
| Rate for Payer: UHCCP Medicaid |
$1,639.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$416.23
|
|
|
DECOMPRESSION OF LOWER LEG(P
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
761P0885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.89 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$767.98
|
| Rate for Payer: Ambetter Exchange |
$452.20
|
| Rate for Payer: Anthem Medicaid |
$321.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$452.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$452.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$542.64
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$840.92
|
| Rate for Payer: Healthspan PPO |
$695.62
|
| Rate for Payer: Humana Medicaid |
$321.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$651.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$452.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$452.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.33
|
| Rate for Payer: Molina Healthcare Passport |
$321.89
|
| Rate for Payer: Multiplan PHCS |
$912.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$587.86
|
| Rate for Payer: UHCCP Medicaid |
$532.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$452.20
|
|
|
DECOMPRESSION OF LOWER LEG(P
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
HCPCS 27601
|
| Hospital Charge Code |
761P0884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$700.62 |
| Rate for Payer: Aetna Commercial |
$642.31
|
| Rate for Payer: Ambetter Exchange |
$416.23
|
| Rate for Payer: Anthem Medicaid |
$253.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$416.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$416.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$499.48
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$700.62
|
| Rate for Payer: Healthspan PPO |
$581.80
|
| Rate for Payer: Humana Medicaid |
$253.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$557.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$416.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$416.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$258.13
|
| Rate for Payer: Molina Healthcare Passport |
$253.07
|
| Rate for Payer: Multiplan PHCS |
$387.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$541.10
|
| Rate for Payer: UHCCP Medicaid |
$225.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$255.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$416.23
|
|
|
DECOMPRESSION OF LOWER LEG(T
|
Facility
|
OP
|
$5,782.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
761T0885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,988.43 |
| Max. Negotiated Rate |
$5,550.72 |
| Rate for Payer: Aetna Commercial |
$4,452.14
|
| Rate for Payer: Anthem Medicaid |
$1,988.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,509.96
|
| 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 |
$2,891.00
|
| Rate for Payer: Cash Price |
$2,891.00
|
| Rate for Payer: Cigna Commercial |
$4,799.06
|
| Rate for Payer: First Health Commercial |
$5,492.90
|
| Rate for Payer: Humana Commercial |
$4,914.70
|
| Rate for Payer: Humana KY Medicaid |
$1,988.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$2,008.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,741.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,267.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,028.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,088.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,336.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,030.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,989.58
|
| Rate for Payer: PHCS Commercial |
$5,550.72
|
| Rate for Payer: United Healthcare All Payer |
$5,088.16
|
|
|
DECOMPRESSION OF LOWER LEG(T
|
Facility
|
IP
|
$4,038.73
|
|
|
Service Code
|
HCPCS 27601
|
| Hospital Charge Code |
761T0884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,211.62 |
| Max. Negotiated Rate |
$3,877.18 |
| Rate for Payer: Aetna Commercial |
$3,109.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.21
|
| Rate for Payer: Cash Price |
$2,019.37
|
| Rate for Payer: Cigna Commercial |
$3,352.15
|
| Rate for Payer: First Health Commercial |
$3,836.79
|
| Rate for Payer: Humana Commercial |
$3,432.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.72
|
| Rate for Payer: PHCS Commercial |
$3,877.18
|
| Rate for Payer: United Healthcare All Payer |
$3,554.08
|
|
|
DECOMPRESSION OF LOWER LEG(T
|
Facility
|
IP
|
$5,782.00
|
|
|
Service Code
|
HCPCS 27602
|
| Hospital Charge Code |
761T0885
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,734.60 |
| Max. Negotiated Rate |
$5,550.72 |
| Rate for Payer: Aetna Commercial |
$4,452.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,509.96
|
| Rate for Payer: Cash Price |
$2,891.00
|
| Rate for Payer: Cigna Commercial |
$4,799.06
|
| Rate for Payer: First Health Commercial |
$5,492.90
|
| Rate for Payer: Humana Commercial |
$4,914.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,741.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,267.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,734.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,088.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,336.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,030.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,989.58
|
| Rate for Payer: PHCS Commercial |
$5,550.72
|
| Rate for Payer: United Healthcare All Payer |
$5,088.16
|
|
|
DECOMPRESSION OF LOWER LEG(T
|
Facility
|
OP
|
$4,038.73
|
|
|
Service Code
|
HCPCS 27601
|
| Hospital Charge Code |
761T0884
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,388.92 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,109.82
|
| Rate for Payer: Anthem Medicaid |
$1,388.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.21
|
| 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 |
$2,019.37
|
| Rate for Payer: Cash Price |
$2,019.37
|
| Rate for Payer: Cigna Commercial |
$3,352.15
|
| Rate for Payer: First Health Commercial |
$3,836.79
|
| Rate for Payer: Humana Commercial |
$3,432.92
|
| Rate for Payer: Humana KY Medicaid |
$1,388.92
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,403.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.72
|
| Rate for Payer: PHCS Commercial |
$3,877.18
|
| Rate for Payer: United Healthcare All Payer |
$3,554.08
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 27496
|
| Hospital Charge Code |
76102945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.87 |
| Max. Negotiated Rate |
$803.55 |
| Rate for Payer: Aetna Commercial |
$729.51
|
| Rate for Payer: Ambetter Exchange |
$525.66
|
| Rate for Payer: Anthem Medicaid |
$278.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$525.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$525.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.79
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$803.55
|
| Rate for Payer: Healthspan PPO |
$660.78
|
| Rate for Payer: Humana Medicaid |
$278.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$646.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$525.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.45
|
| Rate for Payer: Molina Healthcare Passport |
$278.87
|
| Rate for Payer: Multiplan PHCS |
$787.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$683.36
|
| Rate for Payer: UHCCP Medicaid |
$459.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$525.66
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
HCPCS 27496
|
| Hospital Charge Code |
76102945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$451.54 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,011.01
|
| Rate for Payer: Anthem Medicaid |
$451.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.14
|
| 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 |
$656.50
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$1,089.79
|
| Rate for Payer: First Health Commercial |
$1,247.35
|
| Rate for Payer: Humana Commercial |
$1,116.05
|
| Rate for Payer: Humana KY Medicaid |
$451.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$456.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,076.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,155.44
|
| Rate for Payer: Ohio Health Group HMO |
$984.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.97
|
| Rate for Payer: PHCS Commercial |
$1,260.48
|
| Rate for Payer: United Healthcare All Payer |
$1,155.44
|
|
|
DECOMPRESSION OF THIGH/KNEE
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
HCPCS 27496
|
| Hospital Charge Code |
76102945
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$393.90 |
| Max. Negotiated Rate |
$1,260.48 |
| Rate for Payer: Aetna Commercial |
$1,011.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.14
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$1,089.79
|
| Rate for Payer: First Health Commercial |
$1,247.35
|
| Rate for Payer: Humana Commercial |
$1,116.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,076.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,155.44
|
| Rate for Payer: Ohio Health Group HMO |
$984.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.97
|
| Rate for Payer: PHCS Commercial |
$1,260.48
|
| Rate for Payer: United Healthcare All Payer |
$1,155.44
|
|
|
DECOMPRESSION OF TIBIA NERVE
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 28035
|
| Hospital Charge Code |
76102657
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$200.67 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$545.66
|
| Rate for Payer: Ambetter Exchange |
$344.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$200.67
|
| Rate for Payer: Anthem Medicaid |
$329.36
|
| Rate for Payer: Buckeye Individual/Medicaid |
$344.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$344.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$412.99
|
| Rate for Payer: Cash Price |
$807.50
|
| Rate for Payer: Cash Price |
$807.50
|
| Rate for Payer: Cigna Commercial |
$602.55
|
| Rate for Payer: Healthspan PPO |
$648.41
|
| Rate for Payer: Humana Medicaid |
$329.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$442.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$344.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$335.95
|
| Rate for Payer: Molina Healthcare Passport |
$329.36
|
| Rate for Payer: Multiplan PHCS |
$969.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$447.41
|
| Rate for Payer: UHCCP Medicaid |
$210.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$332.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$344.16
|
|
|
DECOMPRESS SMALL BOWEL
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44021
|
| Hospital Charge Code |
76101806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
DECOMPRESS SMALL BOWEL
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44021
|
| Hospital Charge Code |
76101806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.51 |
| Max. Negotiated Rate |
$1,411.01 |
| Rate for Payer: Aetna Commercial |
$1,411.01
|
| Rate for Payer: Ambetter Exchange |
$929.30
|
| Rate for Payer: Anthem Medicaid |
$541.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,115.16
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,301.58
|
| Rate for Payer: Healthspan PPO |
$1,189.93
|
| Rate for Payer: Humana Medicaid |
$541.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,252.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$929.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.34
|
| Rate for Payer: Molina Healthcare Passport |
$541.51
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,208.09
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.30
|
|
|
DECOMPRESS SMALL BOWEL
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44021
|
| Hospital Charge Code |
76101806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,566.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
DECOMPRESS SMALL BOWEL(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44021
|
| Hospital Charge Code |
761P1806
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.51 |
| Max. Negotiated Rate |
$1,411.01 |
| Rate for Payer: Aetna Commercial |
$1,411.01
|
| Rate for Payer: Ambetter Exchange |
$929.30
|
| Rate for Payer: Anthem Medicaid |
$541.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$929.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$929.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,115.16
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,301.58
|
| Rate for Payer: Healthspan PPO |
$1,189.93
|
| Rate for Payer: Humana Medicaid |
$541.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,252.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$929.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$552.34
|
| Rate for Payer: Molina Healthcare Passport |
$541.51
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,208.09
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$546.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$929.30
|
|
