|
APP SHORT LEG SPLNTCALFTOFOOT
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
76101065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$145.79 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
APP SHORT LEG SPLNTCALFTOFOOT
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
45000200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$382.08 |
| Rate for Payer: Aetna Commercial |
$306.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.44
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$330.34
|
| Rate for Payer: First Health Commercial |
$378.10
|
| Rate for Payer: Humana Commercial |
$338.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$326.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$293.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$350.24
|
| Rate for Payer: Ohio Health Group HMO |
$298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.62
|
| Rate for Payer: PHCS Commercial |
$382.08
|
| Rate for Payer: United Healthcare All Payer |
$350.24
|
|
|
APP SHORT LEG SPLNTCALFTOFOOT
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
76101065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$328.80 |
| Rate for Payer: Aetna Commercial |
$73.17
|
| Rate for Payer: Ambetter Exchange |
$47.37
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$35.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.37
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.84
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$105.29
|
| Rate for Payer: Healthspan PPO |
$88.58
|
| Rate for Payer: Humana Medicaid |
$35.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$60.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.20
|
| Rate for Payer: Molina Healthcare Passport |
$35.49
|
| Rate for Payer: Multiplan PHCS |
$328.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.58
|
| Rate for Payer: UHCCP Medicaid |
$41.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.37
|
|
|
APP SHORT LEG SPLNTCALFTOFOOT
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
76101065
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
APP SHORT LEG SPLNTCALFTOFOOT
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
HCPCS 29515
|
| Hospital Charge Code |
45000200
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.87 |
| Max. Negotiated Rate |
$382.08 |
| Rate for Payer: Aetna Commercial |
$306.46
|
| Rate for Payer: Anthem Medicaid |
$136.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$310.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cash Price |
$199.00
|
| Rate for Payer: Cigna Commercial |
$330.34
|
| Rate for Payer: First Health Commercial |
$378.10
|
| Rate for Payer: Humana Commercial |
$338.30
|
| Rate for Payer: Humana KY Medicaid |
$136.87
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$138.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$326.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$293.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$139.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$350.24
|
| Rate for Payer: Ohio Health Group HMO |
$298.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$274.62
|
| Rate for Payer: PHCS Commercial |
$382.08
|
| Rate for Payer: United Healthcare All Payer |
$350.24
|
|
|
APP SKINSUB T/A/L >=100SCM HC
|
Facility
|
IP
|
$4,864.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,459.20 |
| Max. Negotiated Rate |
$4,669.44 |
| Rate for Payer: Aetna Commercial |
$3,745.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,793.92
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cigna Commercial |
$4,037.12
|
| Rate for Payer: First Health Commercial |
$4,620.80
|
| Rate for Payer: Humana Commercial |
$4,134.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,988.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,589.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,280.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,891.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,231.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,356.16
|
| Rate for Payer: PHCS Commercial |
$4,669.44
|
| Rate for Payer: United Healthcare All Payer |
$4,280.32
|
|
|
APP SKINSUB T/A/L >=100SCM HC
|
Facility
|
OP
|
$4,864.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,672.73 |
| Max. Negotiated Rate |
$4,735.72 |
| Rate for Payer: Aetna Commercial |
$3,745.28
|
| Rate for Payer: Anthem Medicaid |
$1,672.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,793.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cigna Commercial |
$4,037.12
|
| Rate for Payer: First Health Commercial |
$4,620.80
|
| Rate for Payer: Humana Commercial |
$4,134.40
|
| Rate for Payer: Humana KY Medicaid |
$1,672.73
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,689.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,988.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,589.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,706.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,280.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,891.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,231.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,356.16
|
| Rate for Payer: PHCS Commercial |
$4,669.44
|
| Rate for Payer: United Healthcare All Payer |
$4,280.32
|
|
|
APP SKINSUB T/A/L >=100SCM HC
|
Professional
|
Both
|
$4,864.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
76100192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.71 |
| Max. Negotiated Rate |
$2,918.40 |
| Rate for Payer: Ambetter Exchange |
$183.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.71
|
| Rate for Payer: Anthem Medicaid |
$233.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.82
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cigna Commercial |
$354.01
|
| Rate for Payer: Healthspan PPO |
$268.95
|
| Rate for Payer: Humana Medicaid |
$233.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$261.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.95
|
| Rate for Payer: Molina Healthcare Passport |
$233.28
|
| Rate for Payer: Multiplan PHCS |
$2,918.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.13
|
| Rate for Payer: UHCCP Medicaid |
$105.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.18
|
|
|
APP SKINSUB T/A/L >=100SCM H(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
761P0192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.71 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Ambetter Exchange |
$183.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.71
|
| Rate for Payer: Anthem Medicaid |
$233.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.82
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$354.01
|
| Rate for Payer: Healthspan PPO |
$268.95
|
| Rate for Payer: Humana Medicaid |
$233.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$261.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.95
|
| Rate for Payer: Molina Healthcare Passport |
$233.28
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.13
|
| Rate for Payer: UHCCP Medicaid |
$105.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$235.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.18
|
|
|
APP SKINSUB T/A/L >=100SCM H(T
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
761T0192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,466.39 |
| Max. Negotiated Rate |
$4,735.72 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem Medicaid |
$1,466.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,382.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,735.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,566.59
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cigna Commercial |
$3,539.12
|
| Rate for Payer: First Health Commercial |
$4,050.80
|
| Rate for Payer: Humana Commercial |
$3,624.40
|
| Rate for Payer: Humana KY Medicaid |
$1,466.39
|
| Rate for Payer: Humana Medicare Advantage |
$3,382.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,481.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,059.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,495.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,752.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,411.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,709.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.16
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
|
APP SKINSUB T/A/L >=100SCM H(T
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
761T0192
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,279.20 |
| Max. Negotiated Rate |
$4,093.44 |
| Rate for Payer: Aetna Commercial |
$3,283.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,325.92
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cigna Commercial |
$3,539.12
|
| Rate for Payer: First Health Commercial |
$4,050.80
|
| Rate for Payer: Humana Commercial |
$3,624.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,496.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,146.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,752.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,411.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,709.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.16
|
| Rate for Payer: PHCS Commercial |
$4,093.44
|
| Rate for Payer: United Healthcare All Payer |
$3,752.32
|
|
|
APP TOPICAL FLUORIDE VARNISH
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99188
|
| Hospital Charge Code |
51000343
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Anthem Medicaid |
$18.75
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Humana Medicaid |
$18.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$13.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.12
|
| Rate for Payer: Molina Healthcare Passport |
$18.75
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$18.94
|
|
|
APP TOPICAL FLUORIDE VARNISH
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 99188
|
| Hospital Charge Code |
51000343
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$12.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$12.04
|
| Rate for Payer: Kentucky WC Medicaid |
$12.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
APP TOPICAL FLUORIDE VARNISH
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 99188
|
| Hospital Charge Code |
51000343
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27.30
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
APP UNIPLANE EXT FIXATION SY(P
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
761P0351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.55 |
| Max. Negotiated Rate |
$782.22 |
| Rate for Payer: Aetna Commercial |
$782.22
|
| Rate for Payer: Ambetter Exchange |
$568.67
|
| Rate for Payer: Anthem Medicaid |
$215.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$682.40
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cash Price |
$625.00
|
| Rate for Payer: Cigna Commercial |
$411.39
|
| Rate for Payer: Healthspan PPO |
$708.53
|
| Rate for Payer: Humana Medicaid |
$215.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.86
|
| Rate for Payer: Molina Healthcare Passport |
$215.55
|
| Rate for Payer: Multiplan PHCS |
$750.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.27
|
| Rate for Payer: UHCCP Medicaid |
$437.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.67
|
|
|
APP UNIPLANE EXT FIXATION SYS
|
Facility
|
OP
|
$9,818.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,376.41 |
| Max. Negotiated Rate |
$9,425.28 |
| Rate for Payer: Aetna Commercial |
$7,559.86
|
| Rate for Payer: Anthem Medicaid |
$3,376.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,658.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cigna Commercial |
$8,148.94
|
| Rate for Payer: First Health Commercial |
$9,327.10
|
| Rate for Payer: Humana Commercial |
$8,345.30
|
| Rate for Payer: Humana KY Medicaid |
$3,376.41
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,410.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,050.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,245.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,444.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,639.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,541.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,774.42
|
| Rate for Payer: PHCS Commercial |
$9,425.28
|
| Rate for Payer: United Healthcare All Payer |
$8,639.84
|
|
|
APP UNIPLANE EXT FIXATION SYS
|
Facility
|
IP
|
$9,818.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,945.40 |
| Max. Negotiated Rate |
$9,425.28 |
| Rate for Payer: Aetna Commercial |
$7,559.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,658.04
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cigna Commercial |
$8,148.94
|
| Rate for Payer: First Health Commercial |
$9,327.10
|
| Rate for Payer: Humana Commercial |
$8,345.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,050.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,245.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,945.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,639.84
|
| Rate for Payer: Ohio Health Group HMO |
$7,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,541.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,774.42
|
| Rate for Payer: PHCS Commercial |
$9,425.28
|
| Rate for Payer: United Healthcare All Payer |
$8,639.84
|
|
|
APP UNIPLANE EXT FIXATION SYS
|
Professional
|
Both
|
$9,818.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
76100351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.55 |
| Max. Negotiated Rate |
$5,890.80 |
| Rate for Payer: Aetna Commercial |
$782.22
|
| Rate for Payer: Ambetter Exchange |
$568.67
|
| Rate for Payer: Anthem Medicaid |
$215.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$568.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$682.40
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cash Price |
$4,909.00
|
| Rate for Payer: Cigna Commercial |
$411.39
|
| Rate for Payer: Healthspan PPO |
$708.53
|
| Rate for Payer: Humana Medicaid |
$215.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$717.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$568.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$219.86
|
| Rate for Payer: Molina Healthcare Passport |
$215.55
|
| Rate for Payer: Multiplan PHCS |
$5,890.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.27
|
| Rate for Payer: UHCCP Medicaid |
$3,436.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$217.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.67
|
|
|
APP UNIPLANE EXT FIXATION SY(T
|
Facility
|
IP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
761T0351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,570.40 |
| Max. Negotiated Rate |
$8,225.28 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,570.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
APP UNIPLANE EXT FIXATION SY(T
|
Facility
|
OP
|
$8,568.00
|
|
|
Service Code
|
HCPCS 20690
|
| Hospital Charge Code |
761T0351
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,946.54 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$6,597.36
|
| Rate for Payer: Anthem Medicaid |
$2,946.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,683.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cash Price |
$4,284.00
|
| Rate for Payer: Cigna Commercial |
$7,111.44
|
| Rate for Payer: First Health Commercial |
$8,139.60
|
| Rate for Payer: Humana Commercial |
$7,282.80
|
| Rate for Payer: Humana KY Medicaid |
$2,946.54
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,025.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,323.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,539.84
|
| Rate for Payer: Ohio Health Group HMO |
$6,426.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,854.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,454.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,911.92
|
| Rate for Payer: PHCS Commercial |
$8,225.28
|
| Rate for Payer: United Healthcare All Payer |
$7,539.84
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$3,702.62
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$3,702.62 |
| Max. Negotiated Rate |
$3,702.62 |
| Rate for Payer: Aetna CHP/Medicaid |
$3,702.62
|
| Rate for Payer: Humana OH Medicaid |
$3,702.62
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$9,613.83
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$9,613.83 |
| Max. Negotiated Rate |
$9,613.83 |
| Rate for Payer: Aetna CHP/Medicaid |
$9,613.83
|
| Rate for Payer: Humana OH Medicaid |
$9,613.83
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$4,677.00
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$4,677.00 |
| Max. Negotiated Rate |
$4,677.00 |
| Rate for Payer: Aetna CHP/Medicaid |
$4,677.00
|
| Rate for Payer: Humana OH Medicaid |
$4,677.00
|
|
|
APR-DRG 42.00: ABDOMINAL PAIN
|
Facility
|
IP
|
$6,106.08
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$6,106.08 |
| Max. Negotiated Rate |
$6,106.08 |
| Rate for Payer: Aetna CHP/Medicaid |
$6,106.08
|
| Rate for Payer: Humana OH Medicaid |
$6,106.08
|
|
|
APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$4,677.00
|
|
|
Service Code
|
APR-DRG 5432
|
| Min. Negotiated Rate |
$4,677.00 |
| Max. Negotiated Rate |
$4,677.00 |
| Rate for Payer: Aetna CHP/Medicaid |
$4,677.00
|
| Rate for Payer: Humana OH Medicaid |
$4,677.00
|
|
