|
FBR MUSCLE OR TENDON SIMPLE
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
76100333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$3,085.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$64.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,085.00
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$240.28
|
| Rate for Payer: Humana Medicaid |
$64.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.57
|
| Rate for Payer: Molina Healthcare Passport |
$64.28
|
| Rate for Payer: Multiplan PHCS |
$1,851.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,159.50
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.92
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Facility
|
IP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$401.05 |
| Max. Negotiated Rate |
$2,961.60 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| Rate for Payer: Cash Price |
$1,542.50
|
| Rate for Payer: Cigna Commercial |
$2,560.55
|
| Rate for Payer: First Health Commercial |
$2,930.75
|
| Rate for Payer: Humana Commercial |
$2,622.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,529.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,276.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,714.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,313.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.35
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
|
FBR MUSCLE OR TENDON SIMPLE(P
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
761P0333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$64.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,035.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$240.28
|
| Rate for Payer: Humana Medicaid |
$64.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.57
|
| Rate for Payer: Molina Healthcare Passport |
$64.28
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$724.50
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.92
|
|
|
FBR MUSCLE OR TENDON SIMPLE(P
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
761P0334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$64.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,035.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$240.28
|
| Rate for Payer: Humana Medicaid |
$64.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.57
|
| Rate for Payer: Molina Healthcare Passport |
$64.28
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$724.50
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.92
|
|
|
FBR MUSCLE OR TENDON SIMPLE(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
761T0333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR MUSCLE OR TENDON SIMPLE(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
761T0333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR MUSCLE OR TENDON SIMPLE(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
761T0334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR MUSCLE OR TENDON SIMPLE(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
761T0334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
OP
|
$717.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
76100012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$688.32 |
| Rate for Payer: Aetna Commercial |
$552.09
|
| Rate for Payer: Anthem Medicaid |
$246.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$559.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$358.50
|
| Rate for Payer: Cash Price |
$358.50
|
| Rate for Payer: Cigna Commercial |
$595.11
|
| Rate for Payer: First Health Commercial |
$681.15
|
| Rate for Payer: Humana Commercial |
$609.45
|
| Rate for Payer: Humana KY Medicaid |
$246.58
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$249.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$587.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$529.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$251.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$630.96
|
| Rate for Payer: Ohio Health Group HMO |
$537.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.27
|
| Rate for Payer: PHCS Commercial |
$688.32
|
| Rate for Payer: United Healthcare All Payer |
$630.96
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
76100012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$717.00 |
| Rate for Payer: Aetna Commercial |
$130.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.60
|
| Rate for Payer: Anthem Medicaid |
$42.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$717.00
|
| Rate for Payer: Cash Price |
$358.50
|
| Rate for Payer: Cash Price |
$358.50
|
| Rate for Payer: Cigna Commercial |
$189.23
|
| Rate for Payer: Healthspan PPO |
$148.34
|
| Rate for Payer: Humana Medicaid |
$42.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.15
|
| Rate for Payer: Molina Healthcare Passport |
$42.30
|
| Rate for Payer: Multiplan PHCS |
$430.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$501.90
|
| Rate for Payer: UHCCP Medicaid |
$55.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.72
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
IP
|
$717.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
76100012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$688.32 |
| Rate for Payer: Aetna Commercial |
$552.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$559.26
|
| Rate for Payer: Cash Price |
$358.50
|
| Rate for Payer: Cigna Commercial |
$595.11
|
| Rate for Payer: First Health Commercial |
$681.15
|
| Rate for Payer: Humana Commercial |
$609.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$587.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$529.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$630.96
|
| Rate for Payer: Ohio Health Group HMO |
$537.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.27
|
| Rate for Payer: PHCS Commercial |
$688.32
|
| Rate for Payer: United Healthcare All Payer |
$630.96
|
|
|
FBR SKIN W/INCISION SIMPLE(P
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
761P0012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$189.23 |
| Rate for Payer: Aetna Commercial |
$130.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.60
|
| Rate for Payer: Anthem Medicaid |
$42.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.00
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$189.23
|
| Rate for Payer: Healthspan PPO |
$148.34
|
| Rate for Payer: Humana Medicaid |
$42.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.15
|
| Rate for Payer: Molina Healthcare Passport |
$42.30
|
| Rate for Payer: Multiplan PHCS |
$109.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$128.10
|
| Rate for Payer: UHCCP Medicaid |
$55.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.72
|
|
|
FBR SKIN W/INCISION SIMPLE(T
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
761T0012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
FBR SKIN W/INCISION SIMPLE(T
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
761T0012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
FBR SKIN W SUBCU COMPLICATED
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
76100013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem Medicaid |
$842.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Humana KY Medicaid |
$842.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$851.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$859.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
FBR SKIN W SUBCU COMPLICATED
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR SKIN W SUBCU COMPLICATED
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
45000023
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR SKIN W SUBCU COMPLICATED
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
76100013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$1,886.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,911.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$2,033.50
|
| Rate for Payer: First Health Commercial |
$2,327.50
|
| Rate for Payer: Humana Commercial |
$2,082.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,009.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,808.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$735.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,156.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$490.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$318.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$759.50
|
| Rate for Payer: PHCS Commercial |
$2,352.00
|
| Rate for Payer: United Healthcare All Payer |
$2,156.00
|
|
|
FBR SKIN W SUBCU COMPLICATED
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
76100013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.61 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: Aetna Commercial |
$269.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.61
|
| Rate for Payer: Anthem Medicaid |
$93.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,450.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cash Price |
$1,225.00
|
| Rate for Payer: Cigna Commercial |
$356.32
|
| Rate for Payer: Healthspan PPO |
$291.94
|
| Rate for Payer: Humana Medicaid |
$93.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.67
|
| Rate for Payer: Molina Healthcare Passport |
$93.79
|
| Rate for Payer: Multiplan PHCS |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,715.00
|
| Rate for Payer: UHCCP Medicaid |
$98.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.73
|
|
|
FBR SKIN W SUBCU COMPLICATED(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
761P0013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.61 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$269.85
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.61
|
| Rate for Payer: Anthem Medicaid |
$93.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$356.32
|
| Rate for Payer: Healthspan PPO |
$291.94
|
| Rate for Payer: Humana Medicaid |
$93.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$227.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$95.67
|
| Rate for Payer: Molina Healthcare Passport |
$93.79
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$98.29
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$94.73
|
|
|
FBR SKIN W SUBCU COMPLICATED(T
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
761T0013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,402.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,962.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,892.73
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$1,402.02
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,682.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR SKIN W SUBCU COMPLICATED(T
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 10121
|
| Hospital Charge Code |
761T0013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FECAL LACTOFERRIN QUAL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 83630
|
| Hospital Charge Code |
30000438
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.34 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67.58
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
