|
FBR FOOT SUBCUTANIOUS
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
45000173
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$539.40 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
FBR FOOT SUBCUTANIOUS
|
Facility
|
IP
|
$2,348.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
76100989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$704.40 |
| Max. Negotiated Rate |
$2,254.08 |
| Rate for Payer: Aetna Commercial |
$1,807.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,831.44
|
| Rate for Payer: Cash Price |
$1,174.00
|
| Rate for Payer: Cigna Commercial |
$1,948.84
|
| Rate for Payer: First Health Commercial |
$2,230.60
|
| Rate for Payer: Humana Commercial |
$1,995.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,925.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,732.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$704.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,066.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,761.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,878.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,042.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,620.12
|
| Rate for Payer: PHCS Commercial |
$2,254.08
|
| Rate for Payer: United Healthcare All Payer |
$2,066.24
|
|
|
FBR FOOT SUBCUTANIOUS(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
761P0989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.21 |
| Max. Negotiated Rate |
$354.18 |
| Rate for Payer: Aetna Commercial |
$202.76
|
| Rate for Payer: Ambetter Exchange |
$125.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$74.17
|
| Rate for Payer: Anthem Medicaid |
$71.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$125.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$150.05
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$354.18
|
| Rate for Payer: Healthspan PPO |
$300.98
|
| Rate for Payer: Humana Medicaid |
$71.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$165.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$125.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.63
|
| Rate for Payer: Molina Healthcare Passport |
$71.21
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$162.55
|
| Rate for Payer: UHCCP Medicaid |
$77.88
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$125.04
|
|
|
FBR FOOT SUBCUTANIOUS(T
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
761T0989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$539.40 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
FBR FOOT SUBCUTANIOUS(T
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
761T0989
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.33 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Humana Medicare Advantage |
$650.10
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$780.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,564.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,240.62
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
45000087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.00 |
| 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 |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Facility
|
OP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
76100333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.93 |
| Max. Negotiated Rate |
$2,961.60 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem Medicaid |
$1,060.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| 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 |
$1,542.50
|
| 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: Humana KY Medicaid |
$1,060.93
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.73
|
| 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 |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.22
|
| 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 |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Facility
|
OP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,060.93 |
| Max. Negotiated Rate |
$2,961.60 |
| Rate for Payer: Aetna Commercial |
$2,375.45
|
| Rate for Payer: Anthem Medicaid |
$1,060.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.30
|
| 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 |
$1,542.50
|
| 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: Humana KY Medicaid |
$1,060.93
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.73
|
| 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 |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.22
|
| 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 |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
76100334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$1,851.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Ambetter Exchange |
$139.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$73.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.41
|
| 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 |
$73.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.29
|
| Rate for Payer: Molina Healthcare Passport |
$73.81
|
| Rate for Payer: Multiplan PHCS |
$1,851.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.36
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.51
|
|
|
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 |
$73.81 |
| Max. Negotiated Rate |
$1,851.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Ambetter Exchange |
$139.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$73.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.41
|
| 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 |
$73.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.29
|
| Rate for Payer: Molina Healthcare Passport |
$73.81
|
| Rate for Payer: Multiplan PHCS |
$1,851.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.36
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.51
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
45000087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
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 |
$925.50 |
| 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 |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| Rate for Payer: PHCS Commercial |
$2,961.60
|
| Rate for Payer: United Healthcare All Payer |
$2,714.80
|
|
|
FBR MUSCLE OR TENDON SIMPLE
|
Facility
|
IP
|
$3,085.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
76100333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$925.50 |
| 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 |
$2,468.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,128.65
|
| 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 |
761P0334
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.81 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Ambetter Exchange |
$139.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$73.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.41
|
| 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 |
$73.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.29
|
| Rate for Payer: Molina Healthcare Passport |
$73.81
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.36
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.51
|
|
|
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 |
$73.81 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$204.79
|
| Rate for Payer: Ambetter Exchange |
$139.51
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$90.29
|
| Rate for Payer: Anthem Medicaid |
$73.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$139.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$139.51
|
| Rate for Payer: CareSource Just4Me Medicare |
$167.41
|
| 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 |
$73.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$176.88
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$139.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.29
|
| Rate for Payer: Molina Healthcare Passport |
$73.81
|
| Rate for Payer: Multiplan PHCS |
$621.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.36
|
| Rate for Payer: UHCCP Medicaid |
$94.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$74.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$139.51
|
|
|
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 |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| 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 |
$705.00 |
| Max. Negotiated Rate |
$2,095.90 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$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 |
$1,497.07
|
| 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 |
$1,796.48
|
| 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 |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| 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 |
$615.00 |
| 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 |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| 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 |
761T0333
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| 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 |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.70 |
| Max. Negotiated Rate |
$546.24 |
| Rate for Payer: Aetna Commercial |
$438.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.82
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$472.27
|
| Rate for Payer: First Health Commercial |
$540.55
|
| Rate for Payer: Humana Commercial |
$483.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.72
|
| Rate for Payer: Ohio Health Group HMO |
$426.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$455.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.61
|
| Rate for Payer: PHCS Commercial |
$546.24
|
| Rate for Payer: United Healthcare All Payer |
$500.72
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
45000021
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.68 |
| Max. Negotiated Rate |
$546.24 |
| Rate for Payer: Aetna Commercial |
$438.13
|
| Rate for Payer: Anthem Medicaid |
$195.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$443.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Cigna Commercial |
$472.27
|
| Rate for Payer: First Health Commercial |
$540.55
|
| Rate for Payer: Humana Commercial |
$483.65
|
| Rate for Payer: Humana KY Medicaid |
$195.68
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$197.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$466.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$419.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$199.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$500.72
|
| Rate for Payer: Ohio Health Group HMO |
$426.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$455.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.61
|
| Rate for Payer: PHCS Commercial |
$546.24
|
| Rate for Payer: United Healthcare All Payer |
$500.72
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Professional
|
Both
|
$752.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
76100012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$451.20 |
| Rate for Payer: Aetna Commercial |
$130.40
|
| Rate for Payer: Ambetter Exchange |
$98.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.60
|
| Rate for Payer: Anthem Medicaid |
$48.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.08
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cigna Commercial |
$189.23
|
| Rate for Payer: Healthspan PPO |
$148.34
|
| Rate for Payer: Humana Medicaid |
$48.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.44
|
| Rate for Payer: Molina Healthcare Passport |
$48.47
|
| Rate for Payer: Multiplan PHCS |
$451.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.92
|
| Rate for Payer: UHCCP Medicaid |
$55.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.40
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
76100012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$225.60 |
| Max. Negotiated Rate |
$721.92 |
| Rate for Payer: Aetna Commercial |
$579.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$586.56
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cigna Commercial |
$624.16
|
| Rate for Payer: First Health Commercial |
$714.40
|
| Rate for Payer: Humana Commercial |
$639.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$616.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$661.76
|
| Rate for Payer: Ohio Health Group HMO |
$564.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.88
|
| Rate for Payer: PHCS Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Payer |
$661.76
|
|
|
FBR SKIN W/INCISION SIMPLE
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
76100012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$258.61 |
| Max. Negotiated Rate |
$721.92 |
| Rate for Payer: Aetna Commercial |
$579.04
|
| Rate for Payer: Anthem Medicaid |
$258.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$586.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cigna Commercial |
$624.16
|
| Rate for Payer: First Health Commercial |
$714.40
|
| Rate for Payer: Humana Commercial |
$639.20
|
| Rate for Payer: Humana KY Medicaid |
$258.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$261.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$616.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$554.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$263.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$661.76
|
| Rate for Payer: Ohio Health Group HMO |
$564.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$601.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$654.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$518.88
|
| Rate for Payer: PHCS Commercial |
$721.92
|
| Rate for Payer: United Healthcare All Payer |
$661.76
|
|
|
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 |
$48.47 |
| Max. Negotiated Rate |
$189.23 |
| Rate for Payer: Aetna Commercial |
$130.40
|
| Rate for Payer: Ambetter Exchange |
$98.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$52.60
|
| Rate for Payer: Anthem Medicaid |
$48.47
|
| Rate for Payer: Buckeye Individual/Medicaid |
$98.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$118.08
|
| 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 |
$48.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$98.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$98.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.44
|
| Rate for Payer: Molina Healthcare Passport |
$48.47
|
| Rate for Payer: Multiplan PHCS |
$109.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$127.92
|
| Rate for Payer: UHCCP Medicaid |
$55.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$98.40
|
|
