|
FIXATION OF KNEE JOINT
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
76100878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| 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 |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
FIXATION OF KNEE JOINT
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
76100878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$480.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$414.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
FIXATION OF KNEE JOINT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
761P0878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Ambetter Exchange |
$147.21
|
| Rate for Payer: Anthem Medicaid |
$102.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.65
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$232.52
|
| Rate for Payer: Healthspan PPO |
$192.82
|
| Rate for Payer: Humana Medicaid |
$102.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$147.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.58
|
| Rate for Payer: Molina Healthcare Passport |
$102.53
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$191.37
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.56
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.21
|
|
|
FIXED CORE J .025 150CM
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
FIXED CORE J .025 150CM
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.80 |
| Max. Negotiated Rate |
$428.16 |
| Rate for Payer: Aetna Commercial |
$343.42
|
| Rate for Payer: Anthem Medicaid |
$153.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.88
|
| Rate for Payer: Cash Price |
$223.00
|
| Rate for Payer: Cigna Commercial |
$370.18
|
| Rate for Payer: First Health Commercial |
$423.70
|
| Rate for Payer: Humana Commercial |
$379.10
|
| Rate for Payer: Humana KY Medicaid |
$153.38
|
| Rate for Payer: Kentucky WC Medicaid |
$154.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$329.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.48
|
| Rate for Payer: Ohio Health Group HMO |
$334.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$388.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$307.74
|
| Rate for Payer: PHCS Commercial |
$428.16
|
| Rate for Payer: United Healthcare All Payer |
$392.48
|
|
|
FIXED CORE J 150CM
|
Facility
|
OP
|
$147.01
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.13 |
| Rate for Payer: Aetna Commercial |
$113.20
|
| Rate for Payer: Anthem Medicaid |
$50.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.67
|
| Rate for Payer: Cash Price |
$73.51
|
| Rate for Payer: Cigna Commercial |
$122.02
|
| Rate for Payer: First Health Commercial |
$139.66
|
| Rate for Payer: Humana Commercial |
$124.96
|
| Rate for Payer: Humana KY Medicaid |
$50.56
|
| Rate for Payer: Kentucky WC Medicaid |
$51.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.37
|
| Rate for Payer: Ohio Health Group HMO |
$110.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.44
|
| Rate for Payer: PHCS Commercial |
$141.13
|
| Rate for Payer: United Healthcare All Payer |
$129.37
|
|
|
FIXED CORE J 150CM
|
Facility
|
IP
|
$147.01
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$141.13 |
| Rate for Payer: Aetna Commercial |
$113.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$114.67
|
| Rate for Payer: Cash Price |
$73.51
|
| Rate for Payer: Cigna Commercial |
$122.02
|
| Rate for Payer: First Health Commercial |
$139.66
|
| Rate for Payer: Humana Commercial |
$124.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$120.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$108.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$129.37
|
| Rate for Payer: Ohio Health Group HMO |
$110.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$117.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$101.44
|
| Rate for Payer: PHCS Commercial |
$141.13
|
| Rate for Payer: United Healthcare All Payer |
$129.37
|
|
|
FIXED CORE J 260CM 49-168
|
Facility
|
OP
|
$490.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.16 |
| Max. Negotiated Rate |
$470.93 |
| Rate for Payer: Aetna Commercial |
$377.72
|
| Rate for Payer: Anthem Medicaid |
$168.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.63
|
| Rate for Payer: Cash Price |
$245.28
|
| Rate for Payer: Cigna Commercial |
$407.16
|
| Rate for Payer: First Health Commercial |
$466.02
|
| Rate for Payer: Humana Commercial |
$416.97
|
| Rate for Payer: Humana KY Medicaid |
$168.70
|
| Rate for Payer: Kentucky WC Medicaid |
$170.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.68
|
| Rate for Payer: Ohio Health Group HMO |
$367.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.48
|
| Rate for Payer: PHCS Commercial |
$470.93
|
| Rate for Payer: United Healthcare All Payer |
$431.68
|
|
|
FIXED CORE J 260CM 49-168
|
Facility
|
IP
|
$490.55
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.16 |
| Max. Negotiated Rate |
$470.93 |
| Rate for Payer: Aetna Commercial |
$377.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$382.63
|
| Rate for Payer: Cash Price |
$245.28
|
| Rate for Payer: Cigna Commercial |
$407.16
|
| Rate for Payer: First Health Commercial |
$466.02
|
| Rate for Payer: Humana Commercial |
$416.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$402.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$431.68
|
| Rate for Payer: Ohio Health Group HMO |
$367.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.48
|
| Rate for Payer: PHCS Commercial |
$470.93
|
| Rate for Payer: United Healthcare All Payer |
$431.68
|
|
|
FIX G/COLON TUBE W/DEVICE
|
Facility
|
IP
|
$2,949.75
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
76102010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$884.92 |
| Max. Negotiated Rate |
$2,831.76 |
| Rate for Payer: Aetna Commercial |
$2,271.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,300.80
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$2,448.29
|
| Rate for Payer: First Health Commercial |
$2,802.26
|
| Rate for Payer: Humana Commercial |
$2,507.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,418.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,176.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,595.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,212.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,359.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,566.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,035.33
|
| Rate for Payer: PHCS Commercial |
$2,831.76
|
| Rate for Payer: United Healthcare All Payer |
$2,595.78
|
|
|
FIX G/COLON TUBE W/DEVICE
|
Professional
|
Both
|
$2,949.75
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
76102010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.69 |
| Max. Negotiated Rate |
$1,769.85 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: Ambetter Exchange |
$47.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.69
|
| Rate for Payer: Anthem Medicaid |
$640.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.98
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$70.12
|
| Rate for Payer: Healthspan PPO |
$979.09
|
| Rate for Payer: Humana Medicaid |
$640.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.69
|
| Rate for Payer: Molina Healthcare Passport |
$640.87
|
| Rate for Payer: Multiplan PHCS |
$1,769.85
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.72
|
| Rate for Payer: UHCCP Medicaid |
$45.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$647.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.48
|
|
|
FIX G/COLON TUBE W/DEVICE
|
Facility
|
OP
|
$2,949.75
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
76102010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$866.29 |
| Max. Negotiated Rate |
$2,831.76 |
| Rate for Payer: Aetna Commercial |
$2,271.31
|
| Rate for Payer: Anthem Medicaid |
$1,014.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,300.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cash Price |
$1,474.88
|
| Rate for Payer: Cigna Commercial |
$2,448.29
|
| Rate for Payer: First Health Commercial |
$2,802.26
|
| Rate for Payer: Humana Commercial |
$2,507.29
|
| Rate for Payer: Humana KY Medicaid |
$1,014.42
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,024.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,418.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,176.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,034.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,595.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,212.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,359.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,566.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,035.33
|
| Rate for Payer: PHCS Commercial |
$2,831.76
|
| Rate for Payer: United Healthcare All Payer |
$2,595.78
|
|
|
FIX G/COLON TUBE W/DEVICE(P
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
761P2010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.69 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$77.72
|
| Rate for Payer: Ambetter Exchange |
$47.48
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$43.69
|
| Rate for Payer: Anthem Medicaid |
$640.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.98
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$70.12
|
| Rate for Payer: Healthspan PPO |
$979.09
|
| Rate for Payer: Humana Medicaid |
$640.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$63.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$653.69
|
| Rate for Payer: Molina Healthcare Passport |
$640.87
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.72
|
| Rate for Payer: UHCCP Medicaid |
$45.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$647.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.48
|
|
|
FIX G/COLON TUBE W/DEVICE(T
|
Facility
|
IP
|
$1,249.75
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
761T2010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$374.93 |
| Max. Negotiated Rate |
$1,199.76 |
| Rate for Payer: Aetna Commercial |
$962.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$974.80
|
| Rate for Payer: Cash Price |
$624.88
|
| Rate for Payer: Cigna Commercial |
$1,037.29
|
| Rate for Payer: First Health Commercial |
$1,187.26
|
| Rate for Payer: Humana Commercial |
$1,062.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,024.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$374.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,099.78
|
| Rate for Payer: Ohio Health Group HMO |
$937.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.33
|
| Rate for Payer: PHCS Commercial |
$1,199.76
|
| Rate for Payer: United Healthcare All Payer |
$1,099.78
|
|
|
FIX G/COLON TUBE W/DEVICE(T
|
Facility
|
OP
|
$1,249.75
|
|
|
Service Code
|
HCPCS 49460
|
| Hospital Charge Code |
761T2010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$429.79 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$962.31
|
| Rate for Payer: Anthem Medicaid |
$429.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$974.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$624.88
|
| Rate for Payer: Cash Price |
$624.88
|
| Rate for Payer: Cigna Commercial |
$1,037.29
|
| Rate for Payer: First Health Commercial |
$1,187.26
|
| Rate for Payer: Humana Commercial |
$1,062.29
|
| Rate for Payer: Humana KY Medicaid |
$429.79
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$434.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,024.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$922.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$438.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,099.78
|
| Rate for Payer: Ohio Health Group HMO |
$937.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$999.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,087.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$862.33
|
| Rate for Payer: PHCS Commercial |
$1,199.76
|
| Rate for Payer: United Healthcare All Payer |
$1,099.78
|
|
|
FLAGYL (METRONIDAZO 250MG/1TAB
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 60687052601
|
| Hospital Charge Code |
25000678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
FLAGYL (METRONIDAZO 250MG/1TAB
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 60687052601
|
| Hospital Charge Code |
25000678
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
FLAGYL (METRONIDAZO 500MG/1TAB
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
25003068
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
FLAGYL (METRONIDAZO 500MG/1TAB
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
25003068
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Anthem Medicaid |
$1.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.86
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna Commercial |
$4.11
|
| Rate for Payer: First Health Commercial |
$4.70
|
| Rate for Payer: Humana Commercial |
$4.21
|
| Rate for Payer: Humana KY Medicaid |
$1.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.36
|
| Rate for Payer: Ohio Health Group HMO |
$3.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.42
|
| Rate for Payer: PHCS Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Payer |
$4.36
|
|
|
FLASH ASP. CATH 16F100CM XTORQ
|
Facility
|
OP
|
$41,637.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12,491.25 |
| Max. Negotiated Rate |
$39,972.00 |
| Rate for Payer: Aetna Commercial |
$32,060.88
|
| Rate for Payer: Anthem Medicaid |
$14,319.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,477.25
|
| Rate for Payer: Cash Price |
$20,818.75
|
| Rate for Payer: Cigna Commercial |
$34,559.12
|
| Rate for Payer: First Health Commercial |
$39,555.62
|
| Rate for Payer: Humana Commercial |
$35,391.88
|
| Rate for Payer: Humana KY Medicaid |
$14,319.14
|
| Rate for Payer: Kentucky WC Medicaid |
$14,464.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,142.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,728.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,491.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,606.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,641.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,228.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,224.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,729.88
|
| Rate for Payer: PHCS Commercial |
$39,972.00
|
| Rate for Payer: United Healthcare All Payer |
$36,641.00
|
|
|
FLASH ASP. CATH 16F100CM XTORQ
|
Facility
|
IP
|
$41,637.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12,491.25 |
| Max. Negotiated Rate |
$39,972.00 |
| Rate for Payer: Aetna Commercial |
$32,060.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,477.25
|
| Rate for Payer: Cash Price |
$20,818.75
|
| Rate for Payer: Cigna Commercial |
$34,559.12
|
| Rate for Payer: First Health Commercial |
$39,555.62
|
| Rate for Payer: Humana Commercial |
$35,391.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,142.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,728.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,491.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,641.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,228.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,310.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,224.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,729.88
|
| Rate for Payer: PHCS Commercial |
$39,972.00
|
| Rate for Payer: United Healthcare All Payer |
$36,641.00
|
|
|
FLAT&UPRIGHABD COMP AP & ERECT
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
320P0118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.82 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Ambetter Exchange |
$33.45
|
| Rate for Payer: Anthem Medicaid |
$25.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.14
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Humana Medicaid |
$25.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.65
|
| Rate for Payer: Molina Healthcare Passport |
$25.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.48
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.40
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.45
|
|
|
FLAT&UPRIGHABD COMP AP & ERECT
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
32000118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$335.32
|
| Rate for Payer: First Health Commercial |
$383.80
|
| Rate for Payer: Humana Commercial |
$343.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$331.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$355.52
|
| Rate for Payer: Ohio Health Group HMO |
$303.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$351.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$278.76
|
| Rate for Payer: PHCS Commercial |
$387.84
|
| Rate for Payer: United Healthcare All Payer |
$355.52
|
|
|
FLAT&UPRIGHABD COMP AP & ERECT
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
320T0118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
FLAT&UPRIGHABD COMP AP & ERECT
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 74019
|
| Hospital Charge Code |
320T0118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
