|
EXCISION VAG CUFF ENDOMETRIOMA
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
EXCISION VAG CUFF ENDOMETRIOMA
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58999
|
| Hospital Charge Code |
76102267
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
EXCIS PILONIDAL CYST - COMPLI
|
Professional
|
Both
|
$7,919.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
76100105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.53 |
| Max. Negotiated Rate |
$7,919.00 |
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$232.53
|
| Rate for Payer: Anthem Medicaid |
$294.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$7,919.00
|
| Rate for Payer: Cash Price |
$3,959.50
|
| Rate for Payer: Cash Price |
$3,959.50
|
| Rate for Payer: Cigna Commercial |
$547.60
|
| Rate for Payer: Healthspan PPO |
$593.75
|
| Rate for Payer: Humana Medicaid |
$294.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.60
|
| Rate for Payer: Molina Healthcare Passport |
$294.71
|
| Rate for Payer: Multiplan PHCS |
$4,751.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,543.30
|
| Rate for Payer: UHCCP Medicaid |
$244.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.66
|
|
|
EXCIS PILONIDAL CYST - COMPLI
|
Facility
|
IP
|
$7,919.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
76100105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,029.47 |
| Max. Negotiated Rate |
$7,602.24 |
| Rate for Payer: Aetna Commercial |
$6,097.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,176.82
|
| Rate for Payer: Cash Price |
$3,959.50
|
| Rate for Payer: Cigna Commercial |
$6,572.77
|
| Rate for Payer: First Health Commercial |
$7,523.05
|
| Rate for Payer: Humana Commercial |
$6,731.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,493.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,844.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,375.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,968.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,939.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,454.89
|
| Rate for Payer: PHCS Commercial |
$7,602.24
|
| Rate for Payer: United Healthcare All Payer |
$6,968.72
|
|
|
EXCIS PILONIDAL CYST - COMPLI
|
Facility
|
OP
|
$7,919.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
76100105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,029.47 |
| Max. Negotiated Rate |
$7,602.24 |
| Rate for Payer: Aetna Commercial |
$6,097.63
|
| Rate for Payer: Anthem Medicaid |
$2,723.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,176.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,959.50
|
| Rate for Payer: Cash Price |
$3,959.50
|
| Rate for Payer: Cigna Commercial |
$6,572.77
|
| Rate for Payer: First Health Commercial |
$7,523.05
|
| Rate for Payer: Humana Commercial |
$6,731.15
|
| Rate for Payer: Humana KY Medicaid |
$2,723.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,751.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,493.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,844.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,968.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,939.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,583.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,454.89
|
| Rate for Payer: PHCS Commercial |
$7,602.24
|
| Rate for Payer: United Healthcare All Payer |
$6,968.72
|
|
|
EXCIS PILONIDAL CYST - COMPL(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
761P0105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.53 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$232.53
|
| Rate for Payer: Anthem Medicaid |
$294.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$547.60
|
| Rate for Payer: Healthspan PPO |
$593.75
|
| Rate for Payer: Humana Medicaid |
$294.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$525.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.60
|
| Rate for Payer: Molina Healthcare Passport |
$294.71
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$244.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.66
|
|
|
EXCIS PILONIDAL CYST - COMPL(T
|
Facility
|
IP
|
$6,919.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
761T0105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$899.47 |
| Max. Negotiated Rate |
$6,642.24 |
| Rate for Payer: Aetna Commercial |
$5,327.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.82
|
| Rate for Payer: Cash Price |
$3,459.50
|
| Rate for Payer: Cigna Commercial |
$5,742.77
|
| Rate for Payer: First Health Commercial |
$6,573.05
|
| Rate for Payer: Humana Commercial |
$5,881.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,106.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,075.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,088.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,189.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,144.89
|
| Rate for Payer: PHCS Commercial |
$6,642.24
|
| Rate for Payer: United Healthcare All Payer |
$6,088.72
|
|
|
EXCIS PILONIDAL CYST - COMPL(T
|
Facility
|
OP
|
$6,919.00
|
|
|
Service Code
|
HCPCS 11771
|
| Hospital Charge Code |
761T0105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$899.47 |
| Max. Negotiated Rate |
$6,642.24 |
| Rate for Payer: Aetna Commercial |
$5,327.63
|
| Rate for Payer: Anthem Medicaid |
$2,379.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,396.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,459.50
|
| Rate for Payer: Cash Price |
$3,459.50
|
| Rate for Payer: Cigna Commercial |
$5,742.77
|
| Rate for Payer: First Health Commercial |
$6,573.05
|
| Rate for Payer: Humana Commercial |
$5,881.15
|
| Rate for Payer: Humana KY Medicaid |
$2,379.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,403.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,673.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,106.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,427.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,088.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,189.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,383.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$899.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,144.89
|
| Rate for Payer: PHCS Commercial |
$6,642.24
|
| Rate for Payer: United Healthcare All Payer |
$6,088.72
|
|
|
EXCIS TUMOR SOFT TIS ARM/DEE(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
761P0503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$687.39
|
| Rate for Payer: Anthem Medicaid |
$291.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$741.84
|
| Rate for Payer: Healthspan PPO |
$622.63
|
| Rate for Payer: Humana Medicaid |
$291.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.17
|
| Rate for Payer: Molina Healthcare Passport |
$291.34
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.25
|
|
|
EXCIS TUMOR SOFT TIS ARM/DEEP
|
Facility
|
OP
|
$6,116.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.08 |
| Max. Negotiated Rate |
$5,871.36 |
| Rate for Payer: Aetna Commercial |
$4,709.32
|
| Rate for Payer: Anthem Medicaid |
$2,103.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,770.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$3,058.00
|
| Rate for Payer: Cash Price |
$3,058.00
|
| Rate for Payer: Cigna Commercial |
$5,076.28
|
| Rate for Payer: First Health Commercial |
$5,810.20
|
| Rate for Payer: Humana Commercial |
$5,198.60
|
| Rate for Payer: Humana KY Medicaid |
$2,103.29
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,124.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,015.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,513.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,145.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,382.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,587.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$795.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,895.96
|
| Rate for Payer: PHCS Commercial |
$5,871.36
|
| Rate for Payer: United Healthcare All Payer |
$5,382.08
|
|
|
EXCIS TUMOR SOFT TIS ARM/DEEP
|
Professional
|
Both
|
$6,116.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$291.34 |
| Max. Negotiated Rate |
$6,116.00 |
| Rate for Payer: Aetna Commercial |
$687.39
|
| Rate for Payer: Anthem Medicaid |
$291.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,116.00
|
| Rate for Payer: Cash Price |
$3,058.00
|
| Rate for Payer: Cash Price |
$3,058.00
|
| Rate for Payer: Cigna Commercial |
$741.84
|
| Rate for Payer: Healthspan PPO |
$622.63
|
| Rate for Payer: Humana Medicaid |
$291.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$297.17
|
| Rate for Payer: Molina Healthcare Passport |
$291.34
|
| Rate for Payer: Multiplan PHCS |
$3,669.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,281.20
|
| Rate for Payer: UHCCP Medicaid |
$2,140.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$294.25
|
|
|
EXCIS TUMOR SOFT TIS ARM/DEEP
|
Facility
|
IP
|
$6,116.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
76100503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$795.08 |
| Max. Negotiated Rate |
$5,871.36 |
| Rate for Payer: Aetna Commercial |
$4,709.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,770.48
|
| Rate for Payer: Cash Price |
$3,058.00
|
| Rate for Payer: Cigna Commercial |
$5,076.28
|
| Rate for Payer: First Health Commercial |
$5,810.20
|
| Rate for Payer: Humana Commercial |
$5,198.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,015.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,513.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,834.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,382.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,587.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,223.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$795.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,895.96
|
| Rate for Payer: PHCS Commercial |
$5,871.36
|
| Rate for Payer: United Healthcare All Payer |
$5,382.08
|
|
|
EXCIS TUMOR SOFT TIS ARM/DEE(T
|
Facility
|
OP
|
$5,366.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
761T0503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.58 |
| Max. Negotiated Rate |
$5,151.36 |
| Rate for Payer: Aetna Commercial |
$4,131.82
|
| Rate for Payer: Anthem Medicaid |
$1,845.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,185.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$4,453.78
|
| Rate for Payer: First Health Commercial |
$5,097.70
|
| Rate for Payer: Humana Commercial |
$4,561.10
|
| Rate for Payer: Humana KY Medicaid |
$1,845.37
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,864.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,882.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,663.46
|
| Rate for Payer: PHCS Commercial |
$5,151.36
|
| Rate for Payer: United Healthcare All Payer |
$4,722.08
|
|
|
EXCIS TUMOR SOFT TIS ARM/DEE(T
|
Facility
|
IP
|
$5,366.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
761T0503
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$697.58 |
| Max. Negotiated Rate |
$5,151.36 |
| Rate for Payer: Aetna Commercial |
$4,131.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,185.48
|
| Rate for Payer: Cash Price |
$2,683.00
|
| Rate for Payer: Cigna Commercial |
$4,453.78
|
| Rate for Payer: First Health Commercial |
$5,097.70
|
| Rate for Payer: Humana Commercial |
$4,561.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,609.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,024.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,663.46
|
| Rate for Payer: PHCS Commercial |
$5,151.36
|
| Rate for Payer: United Healthcare All Payer |
$4,722.08
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
HCPCS 27632
|
| Hospital Charge Code |
76100901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem Medicaid |
$263.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Humana KY Medicaid |
$263.08
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$265.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$268.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.15
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 27632
|
| Hospital Charge Code |
76100901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$633.88
|
| Rate for Payer: Anthem Medicaid |
$299.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$765.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$723.06
|
| Rate for Payer: Healthspan PPO |
$452.73
|
| Rate for Payer: Humana Medicaid |
$299.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.04
|
| Rate for Payer: Molina Healthcare Passport |
$299.06
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$535.50
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.05
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
HCPCS 27632
|
| Hospital Charge Code |
76100901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$734.40 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$596.70
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$634.95
|
| Rate for Payer: First Health Commercial |
$726.75
|
| Rate for Payer: Humana Commercial |
$650.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$627.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$564.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$673.20
|
| Rate for Payer: Ohio Health Group HMO |
$573.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$237.15
|
| Rate for Payer: PHCS Commercial |
$734.40
|
| Rate for Payer: United Healthcare All Payer |
$673.20
|
|
|
EXC LEG/ANKLE LES SC 3 CM/>(P
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 27632
|
| Hospital Charge Code |
761P0901
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Aetna Commercial |
$633.88
|
| Rate for Payer: Anthem Medicaid |
$299.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$765.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$723.06
|
| Rate for Payer: Healthspan PPO |
$452.73
|
| Rate for Payer: Humana Medicaid |
$299.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$526.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.04
|
| Rate for Payer: Molina Healthcare Passport |
$299.06
|
| Rate for Payer: Multiplan PHCS |
$459.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$535.50
|
| Rate for Payer: UHCCP Medicaid |
$267.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.05
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 27619
|
| Hospital Charge Code |
76100897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$996.64 |
| Rate for Payer: Aetna Commercial |
$870.16
|
| Rate for Payer: Anthem Medicaid |
$361.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$665.00
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cigna Commercial |
$949.56
|
| Rate for Payer: Healthspan PPO |
$996.64
|
| Rate for Payer: Humana Medicaid |
$361.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$621.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.44
|
| Rate for Payer: Molina Healthcare Passport |
$361.22
|
| Rate for Payer: Multiplan PHCS |
$399.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$465.50
|
| Rate for Payer: UHCCP Medicaid |
$232.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.83
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
HCPCS 27619
|
| Hospital Charge Code |
76100897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$638.40 |
| Rate for Payer: Aetna Commercial |
$512.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$518.70
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cigna Commercial |
$551.95
|
| Rate for Payer: First Health Commercial |
$631.75
|
| Rate for Payer: Humana Commercial |
$565.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$545.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$585.20
|
| Rate for Payer: Ohio Health Group HMO |
$498.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.15
|
| Rate for Payer: PHCS Commercial |
$638.40
|
| Rate for Payer: United Healthcare All Payer |
$585.20
|
|
|
EXC LEG/ANKLE TUM DEEP <5 CM
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
HCPCS 27619
|
| Hospital Charge Code |
76100897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$512.05
|
| Rate for Payer: Anthem Medicaid |
$228.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$518.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cigna Commercial |
$551.95
|
| Rate for Payer: First Health Commercial |
$631.75
|
| Rate for Payer: Humana Commercial |
$565.25
|
| Rate for Payer: Humana KY Medicaid |
$228.69
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$231.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$545.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$233.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$585.20
|
| Rate for Payer: Ohio Health Group HMO |
$498.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.15
|
| Rate for Payer: PHCS Commercial |
$638.40
|
| Rate for Payer: United Healthcare All Payer |
$585.20
|
|
|
EXC LEG/ANKLE TUM DEEP <5 C(P
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 27619
|
| Hospital Charge Code |
761P0897
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$996.64 |
| Rate for Payer: Aetna Commercial |
$870.16
|
| Rate for Payer: Anthem Medicaid |
$361.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$665.00
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cash Price |
$332.50
|
| Rate for Payer: Cigna Commercial |
$949.56
|
| Rate for Payer: Healthspan PPO |
$996.64
|
| Rate for Payer: Humana Medicaid |
$361.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$621.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$368.44
|
| Rate for Payer: Molina Healthcare Passport |
$361.22
|
| Rate for Payer: Multiplan PHCS |
$399.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$465.50
|
| Rate for Payer: UHCCP Medicaid |
$232.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$364.83
|
|
|
EXC LEG/ANKLE TUM DEP 5 CM/>
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27634
|
| Hospital Charge Code |
76100902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
EXC LEG/ANKLE TUM DEP 5 CM/>
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27634
|
| Hospital Charge Code |
76100902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$3,440.07 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,457.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,440.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,317.21
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,457.19
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
EXC LEG/ANKLE TUM DEP 5 CM/>
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 27634
|
| Hospital Charge Code |
76100902
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.38 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,035.39
|
| Rate for Payer: Anthem Medicaid |
$489.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,181.31
|
| Rate for Payer: Healthspan PPO |
$738.86
|
| Rate for Payer: Humana Medicaid |
$489.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$854.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$499.17
|
| Rate for Payer: Molina Healthcare Passport |
$489.38
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$494.27
|
|
