|
FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28062
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
FASCIOTOMY, FOOT AND/OR TOE
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
76100967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
FASCIOTOMY, FOOT AND/OR TOE
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
76100967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.67 |
| Max. Negotiated Rate |
$543.05 |
| Rate for Payer: Aetna Commercial |
$460.38
|
| Rate for Payer: Ambetter Exchange |
$280.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$149.67
|
| Rate for Payer: Anthem Medicaid |
$201.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$280.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$336.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$504.43
|
| Rate for Payer: Healthspan PPO |
$543.05
|
| Rate for Payer: Humana Medicaid |
$201.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$365.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$280.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.92
|
| Rate for Payer: Molina Healthcare Passport |
$201.88
|
| Rate for Payer: Multiplan PHCS |
$297.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.10
|
| Rate for Payer: UHCCP Medicaid |
$157.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$280.08
|
|
|
FASCIOTOMY, FOOT AND/OR TOE
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
76100967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$170.23 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
FASCIOTOMY, FOOT AND/OR TOE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
FASCIOTOMY, FOOT AND/OR TOE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
76100967
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
FASCIOTOMY, FOOT AND/OR TOE(P
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
761P0967
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.67 |
| Max. Negotiated Rate |
$543.05 |
| Rate for Payer: Aetna Commercial |
$460.38
|
| Rate for Payer: Ambetter Exchange |
$280.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$149.67
|
| Rate for Payer: Anthem Medicaid |
$201.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$280.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$336.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$504.43
|
| Rate for Payer: Healthspan PPO |
$543.05
|
| Rate for Payer: Humana Medicaid |
$201.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$365.12
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$280.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$280.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$205.92
|
| Rate for Payer: Molina Healthcare Passport |
$201.88
|
| Rate for Payer: Multiplan PHCS |
$297.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.10
|
| Rate for Payer: UHCCP Medicaid |
$157.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$203.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$280.08
|
|
|
FASCIOTOMY, HIP/THIGH, ANY
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 27025
|
| Hospital Charge Code |
76100762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
FASCIOTOMY, HIP/THIGH, ANY
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS 27025
|
| Hospital Charge Code |
76100762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem Medicaid |
$385.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Humana KY Medicaid |
$385.17
|
| Rate for Payer: Kentucky WC Medicaid |
$389.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
FASCIOTOMY, HIP/THIGH, ANY
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 27025
|
| Hospital Charge Code |
76100762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$1,404.81 |
| Rate for Payer: Aetna Commercial |
$1,310.51
|
| Rate for Payer: Ambetter Exchange |
$890.77
|
| Rate for Payer: Anthem Medicaid |
$487.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$890.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,068.92
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$1,404.81
|
| Rate for Payer: Healthspan PPO |
$1,187.04
|
| Rate for Payer: Humana Medicaid |
$487.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,129.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$890.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$496.81
|
| Rate for Payer: Molina Healthcare Passport |
$487.07
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,158.00
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$491.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$890.77
|
|
|
FASCIOTOMY, HIP/THIGH, ANY(P
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 27025
|
| Hospital Charge Code |
761P0762
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$1,404.81 |
| Rate for Payer: Aetna Commercial |
$1,310.51
|
| Rate for Payer: Ambetter Exchange |
$890.77
|
| Rate for Payer: Anthem Medicaid |
$487.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$890.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$890.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,068.92
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$1,404.81
|
| Rate for Payer: Healthspan PPO |
$1,187.04
|
| Rate for Payer: Humana Medicaid |
$487.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,129.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$890.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$496.81
|
| Rate for Payer: Molina Healthcare Passport |
$487.07
|
| Rate for Payer: Multiplan PHCS |
$672.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,158.00
|
| Rate for Payer: UHCCP Medicaid |
$392.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$491.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$890.77
|
|
|
FASCIOTOMY - OPEN - PARTIAL
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
76100659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
FASCIOTOMY - OPEN - PARTIAL
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
76100659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.68 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
FASCIOTOMY - OPEN - PARTIAL
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
76100659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.87 |
| Max. Negotiated Rate |
$736.98 |
| Rate for Payer: Aetna Commercial |
$665.73
|
| Rate for Payer: Ambetter Exchange |
$453.17
|
| Rate for Payer: Anthem Medicaid |
$303.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$453.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$543.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$736.98
|
| Rate for Payer: Healthspan PPO |
$603.01
|
| Rate for Payer: Humana Medicaid |
$303.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.95
|
| Rate for Payer: Molina Healthcare Passport |
$303.87
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$589.12
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$306.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$453.17
|
|
|
FASCIOTOMY - OPEN - PARTIAL(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
761P0659
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$303.87 |
| Max. Negotiated Rate |
$736.98 |
| Rate for Payer: Aetna Commercial |
$665.73
|
| Rate for Payer: Ambetter Exchange |
$453.17
|
| Rate for Payer: Anthem Medicaid |
$303.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$453.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$543.80
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$736.98
|
| Rate for Payer: Healthspan PPO |
$603.01
|
| Rate for Payer: Humana Medicaid |
$303.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$570.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$309.95
|
| Rate for Payer: Molina Healthcare Passport |
$303.87
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$589.12
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$306.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$453.17
|
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
76100672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.63 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Ambetter Exchange |
$573.76
|
| Rate for Payer: Anthem Medicaid |
$506.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$573.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$573.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$688.51
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$950.36
|
| Rate for Payer: Healthspan PPO |
$778.78
|
| Rate for Payer: Humana Medicaid |
$506.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$733.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$573.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.76
|
| Rate for Payer: Molina Healthcare Passport |
$506.63
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.89
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$573.76
|
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Facility
|
OP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
76100672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$564.00 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem Medicaid |
$564.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Humana KY Medicaid |
$564.00
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$569.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$575.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.60
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Facility
|
IP
|
$1,640.00
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
76100672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$492.00 |
| Max. Negotiated Rate |
$1,574.40 |
| Rate for Payer: Aetna Commercial |
$1,262.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,279.20
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$1,361.20
|
| Rate for Payer: First Health Commercial |
$1,558.00
|
| Rate for Payer: Humana Commercial |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,344.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,210.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$492.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,443.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,230.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,426.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.60
|
| Rate for Payer: PHCS Commercial |
$1,574.40
|
| Rate for Payer: United Healthcare All Payer |
$1,443.20
|
|
|
FASC PALM WWOZPLST TISREAG/SKN
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 26121
|
| Hospital Charge Code |
761P0672
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.63 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Ambetter Exchange |
$573.76
|
| Rate for Payer: Anthem Medicaid |
$506.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$573.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$573.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$688.51
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cigna Commercial |
$950.36
|
| Rate for Payer: Healthspan PPO |
$778.78
|
| Rate for Payer: Humana Medicaid |
$506.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$733.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$573.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$516.76
|
| Rate for Payer: Molina Healthcare Passport |
$506.63
|
| Rate for Payer: Multiplan PHCS |
$984.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$745.89
|
| Rate for Payer: UHCCP Medicaid |
$574.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$511.70
|
| Rate for Payer: Wellcare Medicare Advantage |
$573.76
|
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
76100673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,273.22 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Ambetter Exchange |
$799.85
|
| Rate for Payer: Anthem Medicaid |
$534.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$799.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$799.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$959.82
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,273.22
|
| Rate for Payer: Healthspan PPO |
$1,061.08
|
| Rate for Payer: Humana Medicaid |
$534.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,019.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$799.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$799.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.48
|
| Rate for Payer: Molina Healthcare Passport |
$534.78
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,039.81
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$799.85
|
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
76100673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$687.80 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
761P0673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$534.78 |
| Max. Negotiated Rate |
$1,273.22 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Ambetter Exchange |
$799.85
|
| Rate for Payer: Anthem Medicaid |
$534.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$799.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$799.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$959.82
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,273.22
|
| Rate for Payer: Healthspan PPO |
$1,061.08
|
| Rate for Payer: Humana Medicaid |
$534.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,019.42
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$799.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$799.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$545.48
|
| Rate for Payer: Molina Healthcare Passport |
$534.78
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,039.81
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$540.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$799.85
|
|
|
FASCT PRTPALM DGT PRX IPHALJT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26123
|
| Hospital Charge Code |
76100673
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
FASENRA 30MG/ML SYRINGE
|
Facility
|
OP
|
$31,866.42
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
25001889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$30,591.76 |
| Rate for Payer: Aetna Commercial |
$24,537.14
|
| Rate for Payer: Anthem Medicaid |
$10,958.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$168.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,855.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$235.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$226.98
|
| Rate for Payer: Cash Price |
$15,933.21
|
| Rate for Payer: Cash Price |
$15,933.21
|
| Rate for Payer: Cigna Commercial |
$26,449.13
|
| Rate for Payer: First Health Commercial |
$30,273.10
|
| Rate for Payer: Humana Commercial |
$27,086.46
|
| Rate for Payer: Humana KY Medicaid |
$10,958.86
|
| Rate for Payer: Humana Medicare Advantage |
$168.13
|
| Rate for Payer: Kentucky WC Medicaid |
$11,070.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,130.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,517.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,178.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,042.45
|
| Rate for Payer: Ohio Health Group HMO |
$23,899.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,493.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,723.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,987.83
|
| Rate for Payer: PHCS Commercial |
$30,591.76
|
| Rate for Payer: United Healthcare All Payer |
$28,042.45
|
|
|
FASENRA 30MG/ML SYRINGE
|
Facility
|
IP
|
$31,866.42
|
|
|
Service Code
|
HCPCS J0517
|
| Hospital Charge Code |
25001889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,559.93 |
| Max. Negotiated Rate |
$30,591.76 |
| Rate for Payer: Aetna Commercial |
$24,537.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,855.81
|
| Rate for Payer: Cash Price |
$15,933.21
|
| Rate for Payer: Cigna Commercial |
$26,449.13
|
| Rate for Payer: First Health Commercial |
$30,273.10
|
| Rate for Payer: Humana Commercial |
$27,086.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26,130.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23,517.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9,559.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$28,042.45
|
| Rate for Payer: Ohio Health Group HMO |
$23,899.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25,493.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27,723.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,987.83
|
| Rate for Payer: PHCS Commercial |
$30,591.76
|
| Rate for Payer: United Healthcare All Payer |
$28,042.45
|
|
