|
EXC FOREARM LES SC > 3 CM(T
|
Facility
|
IP
|
$4,942.00
|
|
|
Service Code
|
HCPCS 25071
|
| Hospital Charge Code |
761T0573
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,482.60 |
| Max. Negotiated Rate |
$4,744.32 |
| Rate for Payer: Aetna Commercial |
$3,805.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,854.76
|
| Rate for Payer: Cash Price |
$2,471.00
|
| Rate for Payer: Cigna Commercial |
$4,101.86
|
| Rate for Payer: First Health Commercial |
$4,694.90
|
| Rate for Payer: Humana Commercial |
$4,200.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,052.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,647.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,482.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,348.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,706.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,953.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,299.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,409.98
|
| Rate for Payer: PHCS Commercial |
$4,744.32
|
| Rate for Payer: United Healthcare All Payer |
$4,348.96
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
OP
|
$6,020.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
76102658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$5,779.20 |
| Rate for Payer: Aetna Commercial |
$4,635.40
|
| Rate for Payer: Anthem Medicaid |
$2,070.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,695.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: Cigna Commercial |
$4,996.60
|
| Rate for Payer: First Health Commercial |
$5,719.00
|
| Rate for Payer: Humana Commercial |
$5,117.00
|
| Rate for Payer: Humana KY Medicaid |
$2,070.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,091.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,936.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,442.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,111.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,297.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,515.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,816.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,237.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,153.80
|
| Rate for Payer: PHCS Commercial |
$5,779.20
|
| Rate for Payer: United Healthcare All Payer |
$5,297.60
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Professional
|
Both
|
$6,020.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
76102658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.37 |
| Max. Negotiated Rate |
$3,612.00 |
| Rate for Payer: Aetna Commercial |
$635.03
|
| Rate for Payer: Ambetter Exchange |
$496.31
|
| Rate for Payer: Anthem Medicaid |
$257.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$496.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$496.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$595.57
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: Cigna Commercial |
$899.28
|
| Rate for Payer: Healthspan PPO |
$575.20
|
| Rate for Payer: Humana Medicaid |
$257.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$638.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$496.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.52
|
| Rate for Payer: Molina Healthcare Passport |
$257.37
|
| Rate for Payer: Multiplan PHCS |
$3,612.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$645.20
|
| Rate for Payer: UHCCP Medicaid |
$2,107.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$259.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$496.31
|
|
|
EXC FOREARM TUM DEEP < 3 CM
|
Facility
|
IP
|
$6,020.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
76102658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,806.00 |
| Max. Negotiated Rate |
$5,779.20 |
| Rate for Payer: Aetna Commercial |
$4,635.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,695.60
|
| Rate for Payer: Cash Price |
$3,010.00
|
| Rate for Payer: Cigna Commercial |
$4,996.60
|
| Rate for Payer: First Health Commercial |
$5,719.00
|
| Rate for Payer: Humana Commercial |
$5,117.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,936.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,442.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,806.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,297.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,515.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,816.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,237.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,153.80
|
| Rate for Payer: PHCS Commercial |
$5,779.20
|
| Rate for Payer: United Healthcare All Payer |
$5,297.60
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
76100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.32 |
| Max. Negotiated Rate |
$3,702.27 |
| Rate for Payer: Aetna Commercial |
$679.14
|
| Rate for Payer: Anthem Medicaid |
$303.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,644.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$687.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,702.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,570.05
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$732.06
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: Humana Commercial |
$749.70
|
| Rate for Payer: Humana KY Medicaid |
$303.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,644.48
|
| Rate for Payer: Kentucky WC Medicaid |
$306.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$723.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,173.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$309.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$776.16
|
| Rate for Payer: Ohio Health Group HMO |
$661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$705.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$767.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.58
|
| Rate for Payer: PHCS Commercial |
$846.72
|
| Rate for Payer: United Healthcare All Payer |
$776.16
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
76100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$923.84 |
| Rate for Payer: Aetna Commercial |
$809.29
|
| Rate for Payer: Ambetter Exchange |
$512.84
|
| Rate for Payer: Anthem Medicaid |
$381.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$512.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$512.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$615.41
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$923.84
|
| Rate for Payer: Healthspan PPO |
$576.72
|
| Rate for Payer: Humana Medicaid |
$381.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$677.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$512.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.40
|
| Rate for Payer: Molina Healthcare Passport |
$381.76
|
| Rate for Payer: Multiplan PHCS |
$529.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$666.69
|
| Rate for Payer: UHCCP Medicaid |
$308.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$512.84
|
|
|
EXC FOREARM TUM DEEP 3 CM/>
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
76100574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$846.72 |
| Rate for Payer: Aetna Commercial |
$679.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$687.96
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$732.06
|
| Rate for Payer: First Health Commercial |
$837.90
|
| Rate for Payer: Humana Commercial |
$749.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$723.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$650.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$264.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$776.16
|
| Rate for Payer: Ohio Health Group HMO |
$661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$705.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$767.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.58
|
| Rate for Payer: PHCS Commercial |
$846.72
|
| Rate for Payer: United Healthcare All Payer |
$776.16
|
|
|
EXC FOREARM TUM DEEP < 3 CM (P
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
761P2658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$257.37 |
| Max. Negotiated Rate |
$899.28 |
| Rate for Payer: Aetna Commercial |
$635.03
|
| Rate for Payer: Ambetter Exchange |
$496.31
|
| Rate for Payer: Anthem Medicaid |
$257.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$496.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$496.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$595.57
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$899.28
|
| Rate for Payer: Healthspan PPO |
$575.20
|
| Rate for Payer: Humana Medicaid |
$257.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$638.15
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$496.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$262.52
|
| Rate for Payer: Molina Healthcare Passport |
$257.37
|
| Rate for Payer: Multiplan PHCS |
$882.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$645.20
|
| Rate for Payer: UHCCP Medicaid |
$514.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$259.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$496.31
|
|
|
EXC FOREARM TUM DEEP 3 CM/>(P
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
761P0574
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$923.84 |
| Rate for Payer: Aetna Commercial |
$809.29
|
| Rate for Payer: Ambetter Exchange |
$512.84
|
| Rate for Payer: Anthem Medicaid |
$381.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$512.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$512.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$615.41
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna Commercial |
$923.84
|
| Rate for Payer: Healthspan PPO |
$576.72
|
| Rate for Payer: Humana Medicaid |
$381.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$677.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$512.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$389.40
|
| Rate for Payer: Molina Healthcare Passport |
$381.76
|
| Rate for Payer: Multiplan PHCS |
$529.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$666.69
|
| Rate for Payer: UHCCP Medicaid |
$308.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$385.58
|
| Rate for Payer: Wellcare Medicare Advantage |
$512.84
|
|
|
EXC FOREARM TUM DEEP < 3 CM (T
|
Facility
|
OP
|
$4,550.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
761T2658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,497.07 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna Commercial |
$3,503.50
|
| Rate for Payer: Anthem Medicaid |
$1,564.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,549.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cigna Commercial |
$3,776.50
|
| Rate for Payer: First Health Commercial |
$4,322.50
|
| Rate for Payer: Humana Commercial |
$3,867.50
|
| Rate for Payer: Humana KY Medicaid |
$1,564.74
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,580.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,731.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,596.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,004.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,958.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,139.50
|
| Rate for Payer: PHCS Commercial |
$4,368.00
|
| Rate for Payer: United Healthcare All Payer |
$4,004.00
|
|
|
EXC FOREARM TUM DEEP < 3 CM (T
|
Facility
|
IP
|
$4,550.00
|
|
|
Service Code
|
HCPCS 25076
|
| Hospital Charge Code |
761T2658
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,365.00 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: Aetna Commercial |
$3,503.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,549.00
|
| Rate for Payer: Cash Price |
$2,275.00
|
| Rate for Payer: Cigna Commercial |
$3,776.50
|
| Rate for Payer: First Health Commercial |
$4,322.50
|
| Rate for Payer: Humana Commercial |
$3,867.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,731.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,365.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,004.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,958.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,139.50
|
| Rate for Payer: PHCS Commercial |
$4,368.00
|
| Rate for Payer: United Healthcare All Payer |
$4,004.00
|
|
|
EXC GANGLION - WRIST
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
76100582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.66 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem Medicaid |
$227.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Humana KY Medicaid |
$227.66
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$229.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.78
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
EXC GANGLION - WRIST
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
76100582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.78
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
EXC GANGLION - WRIST
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
76100582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$523.81 |
| Rate for Payer: Aetna Commercial |
$446.12
|
| Rate for Payer: Ambetter Exchange |
$312.16
|
| Rate for Payer: Anthem Medicaid |
$194.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.59
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$523.81
|
| Rate for Payer: Healthspan PPO |
$404.09
|
| Rate for Payer: Humana Medicaid |
$194.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.70
|
| Rate for Payer: Molina Healthcare Passport |
$194.80
|
| Rate for Payer: Multiplan PHCS |
$397.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.81
|
| Rate for Payer: UHCCP Medicaid |
$231.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.16
|
|
|
EXC GANGLION - WRIST(P
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 25111
|
| Hospital Charge Code |
761P0582
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.80 |
| Max. Negotiated Rate |
$523.81 |
| Rate for Payer: Aetna Commercial |
$446.12
|
| Rate for Payer: Ambetter Exchange |
$312.16
|
| Rate for Payer: Anthem Medicaid |
$194.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$312.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$312.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$374.59
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$523.81
|
| Rate for Payer: Healthspan PPO |
$404.09
|
| Rate for Payer: Humana Medicaid |
$194.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$387.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$312.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$312.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.70
|
| Rate for Payer: Molina Healthcare Passport |
$194.80
|
| Rate for Payer: Multiplan PHCS |
$397.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$405.81
|
| Rate for Payer: UHCCP Medicaid |
$231.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$312.16
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
76100666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$307.50 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$307.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
76100666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Anthem Medicaid |
$352.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$799.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$850.75
|
| Rate for Payer: First Health Commercial |
$973.75
|
| Rate for Payer: Humana Commercial |
$871.25
|
| Rate for Payer: Humana KY Medicaid |
$352.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$356.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$840.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$756.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$359.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$902.00
|
| Rate for Payer: Ohio Health Group HMO |
$768.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$707.25
|
| Rate for Payer: PHCS Commercial |
$984.00
|
| Rate for Payer: United Healthcare All Payer |
$902.00
|
|
|
EXC HAND LES SC 1.5 CM/>
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
76100666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.01 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Aetna Commercial |
$628.27
|
| Rate for Payer: Ambetter Exchange |
$398.33
|
| Rate for Payer: Anthem Medicaid |
$297.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$398.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$478.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: Healthspan PPO |
$447.73
|
| Rate for Payer: Humana Medicaid |
$297.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$398.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.95
|
| Rate for Payer: Molina Healthcare Passport |
$297.01
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.83
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$398.33
|
|
|
EXC HAND LES SC 1.5 CM/>(P
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 26111
|
| Hospital Charge Code |
761P0666
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$297.01 |
| Max. Negotiated Rate |
$718.25 |
| Rate for Payer: Aetna Commercial |
$628.27
|
| Rate for Payer: Ambetter Exchange |
$398.33
|
| Rate for Payer: Anthem Medicaid |
$297.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$398.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$398.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$478.00
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cash Price |
$512.50
|
| Rate for Payer: Cigna Commercial |
$718.25
|
| Rate for Payer: Healthspan PPO |
$447.73
|
| Rate for Payer: Humana Medicaid |
$297.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$528.35
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$398.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.95
|
| Rate for Payer: Molina Healthcare Passport |
$297.01
|
| Rate for Payer: Multiplan PHCS |
$615.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$517.83
|
| Rate for Payer: UHCCP Medicaid |
$358.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.98
|
| Rate for Payer: Wellcare Medicare Advantage |
$398.33
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
76100669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.88 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem Medicaid |
$429.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Humana KY Medicaid |
$429.88
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$434.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
76100669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$754.90 |
| Rate for Payer: Aetna Commercial |
$680.16
|
| Rate for Payer: Ambetter Exchange |
$503.23
|
| Rate for Payer: Anthem Medicaid |
$266.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$603.88
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$754.90
|
| Rate for Payer: Healthspan PPO |
$616.08
|
| Rate for Payer: Humana Medicaid |
$266.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$644.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$503.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$272.21
|
| Rate for Payer: Molina Healthcare Passport |
$266.87
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$654.20
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.23
|
|
|
EXC HAND TUM DEEP < 1.5 CM
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS 26116
|
| Hospital Charge Code |
76100669
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$962.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$975.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$1,037.50
|
| Rate for Payer: First Health Commercial |
$1,187.50
|
| Rate for Payer: Humana Commercial |
$1,062.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,025.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$375.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,100.00
|
| Rate for Payer: Ohio Health Group HMO |
$937.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.50
|
| Rate for Payer: PHCS Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare All Payer |
$1,100.00
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
76100667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
76100667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$438.47 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
EXC HAND TUM DEEP 1.5 CM/>
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
HCPCS 26113
|
| Hospital Charge Code |
76100667
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.87 |
| Max. Negotiated Rate |
$944.92 |
| Rate for Payer: Aetna Commercial |
$826.28
|
| Rate for Payer: Ambetter Exchange |
$524.11
|
| Rate for Payer: Anthem Medicaid |
$390.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$524.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$628.93
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$944.92
|
| Rate for Payer: Healthspan PPO |
$588.82
|
| Rate for Payer: Humana Medicaid |
$390.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$691.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$524.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.69
|
| Rate for Payer: Molina Healthcare Passport |
$390.87
|
| Rate for Payer: Multiplan PHCS |
$765.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$681.34
|
| Rate for Payer: UHCCP Medicaid |
$446.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$524.11
|
|
