|
RBU 5F 3.5
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
RBU 5F 3.5
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
RBU 5F 4.0
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
RBU 5F 4.0
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
RCB 4F 100CM
|
Facility
|
IP
|
$452.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
RCB 4F 100CM
|
Facility
|
OP
|
$452.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$348.62
|
| Rate for Payer: Anthem Medicaid |
$155.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.14
|
| Rate for Payer: Cash Price |
$226.38
|
| Rate for Payer: Cigna Commercial |
$375.78
|
| Rate for Payer: First Health Commercial |
$430.11
|
| Rate for Payer: Humana Commercial |
$384.84
|
| Rate for Payer: Humana KY Medicaid |
$155.70
|
| Rate for Payer: Kentucky WC Medicaid |
$157.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.42
|
| Rate for Payer: Ohio Health Group HMO |
$339.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$362.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$393.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$312.40
|
| Rate for Payer: PHCS Commercial |
$434.64
|
| Rate for Payer: United Healthcare All Payer |
$398.42
|
|
|
RCB 6FR 100CM
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
RCB 6FR 100CM
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
RCNS DIS PATELLA W/RL&/MUSC RL
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
761P0840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.60 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$1,097.57
|
| Rate for Payer: Ambetter Exchange |
$709.68
|
| Rate for Payer: Anthem Medicaid |
$618.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$709.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$709.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$851.62
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,202.35
|
| Rate for Payer: Healthspan PPO |
$994.16
|
| Rate for Payer: Humana Medicaid |
$618.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$921.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$709.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$709.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.97
|
| Rate for Payer: Molina Healthcare Passport |
$618.60
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$922.58
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$709.68
|
|
|
RCNS DIS PATELLA W/RL&/MUSC RL
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
76100840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$615.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
RCNS DIS PATELLA W/RL&/MUSC RL
|
Professional
|
Both
|
$2,050.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
76100840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$618.60 |
| Max. Negotiated Rate |
$1,230.00 |
| Rate for Payer: Aetna Commercial |
$1,097.57
|
| Rate for Payer: Ambetter Exchange |
$709.68
|
| Rate for Payer: Anthem Medicaid |
$618.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$709.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$709.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$851.62
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,202.35
|
| Rate for Payer: Healthspan PPO |
$994.16
|
| Rate for Payer: Humana Medicaid |
$618.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$921.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$709.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$709.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$630.97
|
| Rate for Payer: Molina Healthcare Passport |
$618.60
|
| Rate for Payer: Multiplan PHCS |
$1,230.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$922.58
|
| Rate for Payer: UHCCP Medicaid |
$717.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$624.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$709.68
|
|
|
RCNS DIS PATELLA W/RL&/MUSC RL
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
76100840
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$705.00 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| 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 |
$1,025.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,783.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,414.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
RCNSTJ DISLOCATING PATELLA
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 27420
|
| Hospital Charge Code |
76100839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$902.40 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$817.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.60
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 27420
|
| Hospital Charge Code |
76100839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$1,206.95 |
| Rate for Payer: Aetna Commercial |
$1,102.24
|
| Rate for Payer: Ambetter Exchange |
$712.44
|
| Rate for Payer: Anthem Medicaid |
$605.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$712.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$712.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$854.93
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$1,206.95
|
| Rate for Payer: Healthspan PPO |
$998.40
|
| Rate for Payer: Humana Medicaid |
$605.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$712.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$617.66
|
| Rate for Payer: Molina Healthcare Passport |
$605.55
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$926.17
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$611.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$712.44
|
|
|
RCNSTJ DISLOCATING PATELLA
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS 27420
|
| Hospital Charge Code |
76100839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$323.27 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem Medicaid |
$323.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| 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 |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Humana KY Medicaid |
$323.27
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$326.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$329.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$817.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.60
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
RCNSTJ DISLOCATING PATELLA(P
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 27420
|
| Hospital Charge Code |
761P0839
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$1,206.95 |
| Rate for Payer: Aetna Commercial |
$1,102.24
|
| Rate for Payer: Ambetter Exchange |
$712.44
|
| Rate for Payer: Anthem Medicaid |
$605.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$712.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$712.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$854.93
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$1,206.95
|
| Rate for Payer: Healthspan PPO |
$998.40
|
| Rate for Payer: Humana Medicaid |
$605.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$925.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$712.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$712.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$617.66
|
| Rate for Payer: Molina Healthcare Passport |
$605.55
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$926.17
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$611.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$712.44
|
|
|
RCNST TDN PULLEY W/TDN/FSCAL
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 26502
|
| Hospital Charge Code |
76100710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.21 |
| Max. Negotiated Rate |
$1,197.41 |
| Rate for Payer: Aetna Commercial |
$995.44
|
| Rate for Payer: Ambetter Exchange |
$701.48
|
| Rate for Payer: Anthem Medicaid |
$362.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$701.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$701.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$841.78
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,197.41
|
| Rate for Payer: Healthspan PPO |
$901.65
|
| Rate for Payer: Humana Medicaid |
$362.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$701.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$701.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.45
|
| Rate for Payer: Molina Healthcare Passport |
$362.21
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$911.92
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$701.48
|
|
|
RCNST TDN PULLEY W/TDN/FSCAL
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 26502
|
| Hospital Charge Code |
76100710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$533.04 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem Medicaid |
$533.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Humana KY Medicaid |
$533.04
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
RCNST TDN PULLEY W/TDN/FSCAL
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
HCPCS 26502
|
| Hospital Charge Code |
76100710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,488.00 |
| Rate for Payer: Aetna Commercial |
$1,193.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,286.50
|
| Rate for Payer: First Health Commercial |
$1,472.50
|
| Rate for Payer: Humana Commercial |
$1,317.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,143.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.50
|
| Rate for Payer: PHCS Commercial |
$1,488.00
|
| Rate for Payer: United Healthcare All Payer |
$1,364.00
|
|
|
RCNST TDN PULLEY W/TDN/FSCAL(P
|
Professional
|
Both
|
$1,550.00
|
|
|
Service Code
|
HCPCS 26502
|
| Hospital Charge Code |
761P0710
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$362.21 |
| Max. Negotiated Rate |
$1,197.41 |
| Rate for Payer: Aetna Commercial |
$995.44
|
| Rate for Payer: Ambetter Exchange |
$701.48
|
| Rate for Payer: Anthem Medicaid |
$362.21
|
| Rate for Payer: Buckeye Individual/Medicaid |
$701.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$701.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$841.78
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cash Price |
$775.00
|
| Rate for Payer: Cigna Commercial |
$1,197.41
|
| Rate for Payer: Healthspan PPO |
$901.65
|
| Rate for Payer: Humana Medicaid |
$362.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$701.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$701.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$369.45
|
| Rate for Payer: Molina Healthcare Passport |
$362.21
|
| Rate for Payer: Multiplan PHCS |
$930.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$911.92
|
| Rate for Payer: UHCCP Medicaid |
$542.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$365.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$701.48
|
|
|
RCNST TNDN PULLEY WLOC TISS
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26500
|
| Hospital Charge Code |
76100709
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.57 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$876.69
|
| Rate for Payer: Ambetter Exchange |
$637.02
|
| Rate for Payer: Anthem Medicaid |
$274.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$637.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$637.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.42
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,075.74
|
| Rate for Payer: Healthspan PPO |
$794.09
|
| Rate for Payer: Humana Medicaid |
$274.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$280.06
|
| Rate for Payer: Molina Healthcare Passport |
$274.57
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$828.13
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$277.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$637.02
|
|
|
RCNST TNDN PULLEY WLOC TISS
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26500
|
| Hospital Charge Code |
76100709
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
RCNST TNDN PULLEY WLOC TISS
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26500
|
| Hospital Charge Code |
76100709
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$447.07 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| 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 |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,040.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$897.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
RCNST TNDN PULLEY WLOC TISS (P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26500
|
| Hospital Charge Code |
761P0709
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.57 |
| Max. Negotiated Rate |
$1,075.74 |
| Rate for Payer: Aetna Commercial |
$876.69
|
| Rate for Payer: Ambetter Exchange |
$637.02
|
| Rate for Payer: Anthem Medicaid |
$274.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$637.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$637.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$764.42
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,075.74
|
| Rate for Payer: Healthspan PPO |
$794.09
|
| Rate for Payer: Humana Medicaid |
$274.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$757.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$280.06
|
| Rate for Payer: Molina Healthcare Passport |
$274.57
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$828.13
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$277.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$637.02
|
|
|
RCS COCR CABLE/SWAGE 1.6
|
Facility
|
OP
|
$3,265.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.63 |
| Max. Negotiated Rate |
$3,134.82 |
| Rate for Payer: Aetna Commercial |
$2,514.39
|
| Rate for Payer: Anthem Medicaid |
$1,122.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,547.04
|
| Rate for Payer: Cash Price |
$1,632.72
|
| Rate for Payer: Cigna Commercial |
$2,710.32
|
| Rate for Payer: First Health Commercial |
$3,102.17
|
| Rate for Payer: Humana Commercial |
$2,775.62
|
| Rate for Payer: Humana KY Medicaid |
$1,122.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,134.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,677.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,409.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,873.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,449.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,612.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,840.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.15
|
| Rate for Payer: PHCS Commercial |
$3,134.82
|
| Rate for Payer: United Healthcare All Payer |
$2,873.59
|
|
