|
FOLVITE(FOLIC ACID)(0.1MG)50MG
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS J1808
|
| Hospital Charge Code |
25003076
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.98
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.79
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
FOOT & ANKLE KIT 3CC END 11G
|
Facility
|
IP
|
$14,469.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,340.89 |
| Max. Negotiated Rate |
$13,890.84 |
| Rate for Payer: Aetna Commercial |
$11,141.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,286.31
|
| Rate for Payer: Cash Price |
$7,234.81
|
| Rate for Payer: Cigna Commercial |
$12,009.79
|
| Rate for Payer: First Health Commercial |
$13,746.15
|
| Rate for Payer: Humana Commercial |
$12,299.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,678.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,340.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,733.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,852.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,575.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,984.04
|
| Rate for Payer: PHCS Commercial |
$13,890.84
|
| Rate for Payer: United Healthcare All Payer |
$12,733.27
|
|
|
FOOT & ANKLE KIT 3CC END 11G
|
Facility
|
OP
|
$14,469.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,340.89 |
| Max. Negotiated Rate |
$13,890.84 |
| Rate for Payer: Aetna Commercial |
$11,141.62
|
| Rate for Payer: Anthem Medicaid |
$4,976.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,286.31
|
| Rate for Payer: Cash Price |
$7,234.81
|
| Rate for Payer: Cigna Commercial |
$12,009.79
|
| Rate for Payer: First Health Commercial |
$13,746.15
|
| Rate for Payer: Humana Commercial |
$12,299.19
|
| Rate for Payer: Humana KY Medicaid |
$4,976.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,026.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,678.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,340.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,075.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,733.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,852.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,575.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,984.04
|
| Rate for Payer: PHCS Commercial |
$13,890.84
|
| Rate for Payer: United Healthcare All Payer |
$12,733.27
|
|
|
FOOT & ANKLE KIT 3CC END 15G
|
Facility
|
IP
|
$14,469.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,340.89 |
| Max. Negotiated Rate |
$13,890.84 |
| Rate for Payer: Aetna Commercial |
$11,141.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,286.31
|
| Rate for Payer: Cash Price |
$7,234.81
|
| Rate for Payer: Cigna Commercial |
$12,009.79
|
| Rate for Payer: First Health Commercial |
$13,746.15
|
| Rate for Payer: Humana Commercial |
$12,299.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,678.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,340.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,733.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,852.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,575.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,984.04
|
| Rate for Payer: PHCS Commercial |
$13,890.84
|
| Rate for Payer: United Healthcare All Payer |
$12,733.27
|
|
|
FOOT & ANKLE KIT 3CC END 15G
|
Facility
|
OP
|
$14,469.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,340.89 |
| Max. Negotiated Rate |
$13,890.84 |
| Rate for Payer: Aetna Commercial |
$11,141.62
|
| Rate for Payer: Anthem Medicaid |
$4,976.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,286.31
|
| Rate for Payer: Cash Price |
$7,234.81
|
| Rate for Payer: Cigna Commercial |
$12,009.79
|
| Rate for Payer: First Health Commercial |
$13,746.15
|
| Rate for Payer: Humana Commercial |
$12,299.19
|
| Rate for Payer: Humana KY Medicaid |
$4,976.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,026.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,678.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,340.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,075.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,733.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,852.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,575.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,984.04
|
| Rate for Payer: PHCS Commercial |
$13,890.84
|
| Rate for Payer: United Healthcare All Payer |
$12,733.27
|
|
|
FOOT & ANKLE KIT 3CC SIDE 11G
|
Facility
|
IP
|
$14,469.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,340.89 |
| Max. Negotiated Rate |
$13,890.84 |
| Rate for Payer: Aetna Commercial |
$11,141.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,286.31
|
| Rate for Payer: Cash Price |
$7,234.81
|
| Rate for Payer: Cigna Commercial |
$12,009.79
|
| Rate for Payer: First Health Commercial |
$13,746.15
|
| Rate for Payer: Humana Commercial |
$12,299.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,678.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,340.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,733.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,852.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,575.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,984.04
|
| Rate for Payer: PHCS Commercial |
$13,890.84
|
| Rate for Payer: United Healthcare All Payer |
$12,733.27
|
|
|
FOOT & ANKLE KIT 3CC SIDE 11G
|
Facility
|
OP
|
$14,469.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,340.89 |
| Max. Negotiated Rate |
$13,890.84 |
| Rate for Payer: Aetna Commercial |
$11,141.62
|
| Rate for Payer: Anthem Medicaid |
$4,976.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,286.31
|
| Rate for Payer: Cash Price |
$7,234.81
|
| Rate for Payer: Cigna Commercial |
$12,009.79
|
| Rate for Payer: First Health Commercial |
$13,746.15
|
| Rate for Payer: Humana Commercial |
$12,299.19
|
| Rate for Payer: Humana KY Medicaid |
$4,976.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,026.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,865.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,678.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,340.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,075.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,733.27
|
| Rate for Payer: Ohio Health Group HMO |
$10,852.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,575.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,984.04
|
| Rate for Payer: PHCS Commercial |
$13,890.84
|
| Rate for Payer: United Healthcare All Payer |
$12,733.27
|
|
|
FOOT & ANKLE KIT 5CC END 11G
|
Facility
|
IP
|
$20,386.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,115.88 |
| Max. Negotiated Rate |
$19,570.80 |
| Rate for Payer: Aetna Commercial |
$15,697.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,901.27
|
| Rate for Payer: Cash Price |
$10,193.12
|
| Rate for Payer: Cigna Commercial |
$16,920.59
|
| Rate for Payer: First Health Commercial |
$19,366.94
|
| Rate for Payer: Humana Commercial |
$17,328.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,716.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,045.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,115.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,939.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,289.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,309.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,736.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,066.51
|
| Rate for Payer: PHCS Commercial |
$19,570.80
|
| Rate for Payer: United Healthcare All Payer |
$17,939.90
|
|
|
FOOT & ANKLE KIT 5CC END 11G
|
Facility
|
OP
|
$20,386.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,115.88 |
| Max. Negotiated Rate |
$19,570.80 |
| Rate for Payer: Aetna Commercial |
$15,697.41
|
| Rate for Payer: Anthem Medicaid |
$7,010.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,901.27
|
| Rate for Payer: Cash Price |
$10,193.12
|
| Rate for Payer: Cigna Commercial |
$16,920.59
|
| Rate for Payer: First Health Commercial |
$19,366.94
|
| Rate for Payer: Humana Commercial |
$17,328.31
|
| Rate for Payer: Humana KY Medicaid |
$7,010.83
|
| Rate for Payer: Kentucky WC Medicaid |
$7,082.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,716.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,045.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,115.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,151.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,939.90
|
| Rate for Payer: Ohio Health Group HMO |
$15,289.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,309.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,736.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,066.51
|
| Rate for Payer: PHCS Commercial |
$19,570.80
|
| Rate for Payer: United Healthcare All Payer |
$17,939.90
|
|
|
FOOT LT 2V
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
32000109
|
|
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
|
|
|
FOOT LT 2V
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$387.84 |
| Rate for Payer: Aetna Commercial |
$311.08
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$202.00
|
| 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: Humana KY Medicaid |
$138.94
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$140.35
|
| 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 |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.72
|
| 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
|
|
|
FOOT LT 2V
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$242.40 |
| Rate for Payer: Aetna Commercial |
$39.20
|
| Rate for Payer: Ambetter Exchange |
$25.59
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.71
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cash Price |
$202.00
|
| Rate for Payer: Cigna Commercial |
$39.75
|
| Rate for Payer: Healthspan PPO |
$36.73
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$242.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.27
|
| Rate for Payer: UHCCP Medicaid |
$141.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.59
|
|
|
FOOT LT 2V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
320P0109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Commercial |
$39.20
|
| Rate for Payer: Ambetter Exchange |
$25.59
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$25.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.71
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$39.75
|
| Rate for Payer: Healthspan PPO |
$36.73
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$25.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$33.27
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$25.59
|
|
|
FOOT LT 2V(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
320T0109
|
|
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
|
|
|
FOOT LT 2V(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
320T0109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| 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 |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| 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 |
$81.36
|
| 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 |
$97.63
|
| 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
|
|
|
FOOT LT MIN OF 3V
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FOOT LT MIN OF 3V
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Ambetter Exchange |
$30.63
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.76
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$42.80
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.82
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.63
|
|
|
FOOT LT MIN OF 3V
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FOOT LT MIN OF 3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
320P0110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Ambetter Exchange |
$30.63
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.76
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$42.80
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.82
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.63
|
|
|
FOOT LT MIN OF 3V(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
320T0110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
FOOT LT MIN OF 3V(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
320T0110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
FOOT RING PLATE 210MM
|
Facility
|
OP
|
$7,406.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,221.81 |
| Max. Negotiated Rate |
$7,109.78 |
| Rate for Payer: Aetna Commercial |
$5,702.64
|
| Rate for Payer: Anthem Medicaid |
$2,546.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,776.70
|
| Rate for Payer: Cash Price |
$3,703.01
|
| Rate for Payer: Cigna Commercial |
$6,147.00
|
| Rate for Payer: First Health Commercial |
$7,035.72
|
| Rate for Payer: Humana Commercial |
$6,295.12
|
| Rate for Payer: Humana KY Medicaid |
$2,546.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,572.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,072.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,465.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,221.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,598.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,517.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,554.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,924.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,443.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,110.15
|
| Rate for Payer: PHCS Commercial |
$7,109.78
|
| Rate for Payer: United Healthcare All Payer |
$6,517.30
|
|
|
FOOT RING PLATE 210MM
|
Facility
|
IP
|
$7,406.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,221.81 |
| Max. Negotiated Rate |
$7,109.78 |
| Rate for Payer: Aetna Commercial |
$5,702.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,776.70
|
| Rate for Payer: Cash Price |
$3,703.01
|
| Rate for Payer: Cigna Commercial |
$6,147.00
|
| Rate for Payer: First Health Commercial |
$7,035.72
|
| Rate for Payer: Humana Commercial |
$6,295.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,072.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,465.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,221.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,517.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,554.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,924.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,443.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,110.15
|
| Rate for Payer: PHCS Commercial |
$7,109.78
|
| Rate for Payer: United Healthcare All Payer |
$6,517.30
|
|
|
FOOT/TOES SURGERY PROCEDURE
|
Facility
|
IP
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76101045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,243.81 |
| Max. Negotiated Rate |
$3,980.19 |
| Rate for Payer: Aetna Commercial |
$3,192.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.90
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cigna Commercial |
$3,441.20
|
| Rate for Payer: First Health Commercial |
$3,938.73
|
| Rate for Payer: Humana Commercial |
$3,524.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,607.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.76
|
| Rate for Payer: PHCS Commercial |
$3,980.19
|
| Rate for Payer: United Healthcare All Payer |
$3,648.51
|
|
|
FOOT/TOES SURGERY PROCEDURE
|
Facility
|
OP
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76101045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$3,980.19 |
| Rate for Payer: Aetna Commercial |
$3,192.44
|
| Rate for Payer: Anthem Medicaid |
$1,425.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cigna Commercial |
$3,441.20
|
| Rate for Payer: First Health Commercial |
$3,938.73
|
| Rate for Payer: Humana Commercial |
$3,524.13
|
| Rate for Payer: Humana KY Medicaid |
$1,425.82
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,440.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,607.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.76
|
| Rate for Payer: PHCS Commercial |
$3,980.19
|
| Rate for Payer: United Healthcare All Payer |
$3,648.51
|
|
