|
REPAIR BOWEL-SKIN FISTULA
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44640
|
| Hospital Charge Code |
76101862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
REPAIR BOWEL-SKIN FISTULA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 44640
|
| Hospital Charge Code |
761P1862
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$599.66 |
| Max. Negotiated Rate |
$2,044.74 |
| Rate for Payer: Aetna Commercial |
$2,044.74
|
| Rate for Payer: Anthem Medicaid |
$599.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,904.65
|
| Rate for Payer: Healthspan PPO |
$1,724.37
|
| Rate for Payer: Humana Medicaid |
$599.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,796.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$611.65
|
| Rate for Payer: Molina Healthcare Passport |
$599.66
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$605.66
|
|
|
REPAIR BRONCHO PLEURAL FISTULA
|
Facility
|
OP
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32815
|
| Hospital Charge Code |
76101232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$2,849.00
|
| Rate for Payer: Anthem Medicaid |
$1,272.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,071.00
|
| Rate for Payer: First Health Commercial |
$3,515.00
|
| Rate for Payer: Humana Commercial |
$3,145.00
|
| Rate for Payer: Humana KY Medicaid |
$1,272.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,147.00
|
| Rate for Payer: PHCS Commercial |
$3,552.00
|
| Rate for Payer: United Healthcare All Payer |
$3,256.00
|
|
|
REPAIR BRONCHO PLEURAL FISTULA
|
Facility
|
IP
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32815
|
| Hospital Charge Code |
76101232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$3,552.00 |
| Rate for Payer: Aetna Commercial |
$2,849.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,886.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,071.00
|
| Rate for Payer: First Health Commercial |
$3,515.00
|
| Rate for Payer: Humana Commercial |
$3,145.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,034.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,110.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,256.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,775.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$481.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,147.00
|
| Rate for Payer: PHCS Commercial |
$3,552.00
|
| Rate for Payer: United Healthcare All Payer |
$3,256.00
|
|
|
REPAIR BRONCHO PLEURAL FISTULA
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32815
|
| Hospital Charge Code |
76101232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,098.67 |
| Max. Negotiated Rate |
$4,369.77 |
| Rate for Payer: Aetna Commercial |
$4,369.77
|
| Rate for Payer: Anthem Medicaid |
$1,098.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,700.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,853.12
|
| Rate for Payer: Healthspan PPO |
$3,411.80
|
| Rate for Payer: Humana Medicaid |
$1,098.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,859.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,120.64
|
| Rate for Payer: Molina Healthcare Passport |
$1,098.67
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,590.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,109.66
|
|
|
REPAIR BRONCHO PLEURAL FISTULA
|
Professional
|
Both
|
$3,700.00
|
|
|
Service Code
|
HCPCS 32815
|
| Hospital Charge Code |
761P1232
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,098.67 |
| Max. Negotiated Rate |
$4,369.77 |
| Rate for Payer: Aetna Commercial |
$4,369.77
|
| Rate for Payer: Anthem Medicaid |
$1,098.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,700.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cash Price |
$1,850.00
|
| Rate for Payer: Cigna Commercial |
$3,853.12
|
| Rate for Payer: Healthspan PPO |
$3,411.80
|
| Rate for Payer: Humana Medicaid |
$1,098.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,859.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,120.64
|
| Rate for Payer: Molina Healthcare Passport |
$1,098.67
|
| Rate for Payer: Multiplan PHCS |
$2,220.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,590.00
|
| Rate for Payer: UHCCP Medicaid |
$1,295.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,109.66
|
|
|
REPAIR BROW PTOSIS
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 67900
|
| Hospital Charge Code |
76102393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
REPAIR BROW PTOSIS
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 67900
|
| Hospital Charge Code |
76102393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$2,829.05 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,020.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,829.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,728.01
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,020.75
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 67900
|
| Hospital Charge Code |
76102393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.47 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$676.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.32
|
| Rate for Payer: Anthem Medicaid |
$239.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$659.84
|
| Rate for Payer: Healthspan PPO |
$741.67
|
| Rate for Payer: Humana Medicaid |
$239.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$642.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.26
|
| Rate for Payer: Molina Healthcare Passport |
$239.47
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$265.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.86
|
|
|
REPAIR BROW PTOSIS(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 67900
|
| Hospital Charge Code |
761P2393
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.47 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$676.07
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$253.32
|
| Rate for Payer: Anthem Medicaid |
$239.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$659.84
|
| Rate for Payer: Healthspan PPO |
$741.67
|
| Rate for Payer: Humana Medicaid |
$239.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$642.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.26
|
| Rate for Payer: Molina Healthcare Passport |
$239.47
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$265.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.86
|
|
|
REPAIR CARDIAC WOUND W/O BYPAS
|
Facility
|
IP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 33300
|
| Hospital Charge Code |
76101282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$2,976.00 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$2,573.00
|
| Rate for Payer: First Health Commercial |
$2,945.00
|
| Rate for Payer: Humana Commercial |
$2,635.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
REPAIR CARDIAC WOUND W/O BYPAS
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 33300
|
| Hospital Charge Code |
761P1282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$923.41 |
| Max. Negotiated Rate |
$3,847.18 |
| Rate for Payer: Aetna Commercial |
$3,847.18
|
| Rate for Payer: Anthem Medicaid |
$923.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,100.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$3,403.66
|
| Rate for Payer: Healthspan PPO |
$3,782.53
|
| Rate for Payer: Humana Medicaid |
$923.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,404.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$941.88
|
| Rate for Payer: Molina Healthcare Passport |
$923.41
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,170.00
|
| Rate for Payer: UHCCP Medicaid |
$1,085.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$932.64
|
|
|
REPAIR CARDIAC WOUND W/O BYPAS
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 33300
|
| Hospital Charge Code |
76101282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$923.41 |
| Max. Negotiated Rate |
$3,847.18 |
| Rate for Payer: Aetna Commercial |
$3,847.18
|
| Rate for Payer: Anthem Medicaid |
$923.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,100.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$3,403.66
|
| Rate for Payer: Healthspan PPO |
$3,782.53
|
| Rate for Payer: Humana Medicaid |
$923.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,404.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$941.88
|
| Rate for Payer: Molina Healthcare Passport |
$923.41
|
| Rate for Payer: Multiplan PHCS |
$1,860.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,170.00
|
| Rate for Payer: UHCCP Medicaid |
$1,085.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$932.64
|
|
|
REPAIR CARDIAC WOUND W/O BYPAS
|
Facility
|
OP
|
$3,100.00
|
|
|
Service Code
|
HCPCS 33300
|
| Hospital Charge Code |
76101282
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$403.00 |
| Max. Negotiated Rate |
$2,976.00 |
| Rate for Payer: Aetna Commercial |
$2,387.00
|
| Rate for Payer: Anthem Medicaid |
$1,066.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,418.00
|
| Rate for Payer: Cash Price |
$1,550.00
|
| Rate for Payer: Cigna Commercial |
$2,573.00
|
| Rate for Payer: First Health Commercial |
$2,945.00
|
| Rate for Payer: Humana Commercial |
$2,635.00
|
| Rate for Payer: Humana KY Medicaid |
$1,066.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,076.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,542.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,087.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,728.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,325.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.00
|
| Rate for Payer: PHCS Commercial |
$2,976.00
|
| Rate for Payer: United Healthcare All Payer |
$2,728.00
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 C
|
Facility
|
OP
|
$1,740.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Aetna Commercial |
$1,339.80
|
| Rate for Payer: Anthem Medicaid |
$598.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,444.20
|
| Rate for Payer: First Health Commercial |
$1,653.00
|
| Rate for Payer: Humana Commercial |
$1,479.00
|
| Rate for Payer: Humana KY Medicaid |
$598.39
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$604.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.40
|
| Rate for Payer: PHCS Commercial |
$1,670.40
|
| Rate for Payer: United Healthcare All Payer |
$1,531.20
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 C
|
Facility
|
IP
|
$1,740.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Aetna Commercial |
$1,339.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.20
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$1,444.20
|
| Rate for Payer: First Health Commercial |
$1,653.00
|
| Rate for Payer: Humana Commercial |
$1,479.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.40
|
| Rate for Payer: PHCS Commercial |
$1,670.40
|
| Rate for Payer: United Healthcare All Payer |
$1,531.20
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 C
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem Medicaid |
$443.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Humana KY Medicaid |
$443.63
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$448.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 C
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
76100155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$393.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.16
|
| Rate for Payer: Anthem Medicaid |
$141.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,740.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cash Price |
$870.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: Healthspan PPO |
$398.63
|
| Rate for Payer: Humana Medicaid |
$141.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$345.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.73
|
| Rate for Payer: Molina Healthcare Passport |
$141.89
|
| Rate for Payer: Multiplan PHCS |
$1,044.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,218.00
|
| Rate for Payer: UHCCP Medicaid |
$128.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.31
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 C
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
45000072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 (P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
761P0155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$466.46 |
| Rate for Payer: Aetna Commercial |
$393.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.16
|
| Rate for Payer: Anthem Medicaid |
$141.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$450.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$466.46
|
| Rate for Payer: Healthspan PPO |
$398.63
|
| Rate for Payer: Humana Medicaid |
$141.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$345.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$144.73
|
| Rate for Payer: Molina Healthcare Passport |
$141.89
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$128.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.31
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 (T
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
761T0155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem Medicaid |
$443.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Humana KY Medicaid |
$443.63
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$448.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
REPAIR - COMPLEX 1.1 TO 2.5 (T
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 13131
|
| Hospital Charge Code |
761T0155
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
REPAIR COMPLEX 5CM OR LESS
|
Facility
|
IP
|
$2,133.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.29 |
| Max. Negotiated Rate |
$2,047.68 |
| Rate for Payer: Aetna Commercial |
$1,642.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,663.74
|
| Rate for Payer: Cash Price |
$1,066.50
|
| Rate for Payer: Cigna Commercial |
$1,770.39
|
| Rate for Payer: First Health Commercial |
$2,026.35
|
| Rate for Payer: Humana Commercial |
$1,813.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,749.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,574.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,877.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,599.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.23
|
| Rate for Payer: PHCS Commercial |
$2,047.68
|
| Rate for Payer: United Healthcare All Payer |
$1,877.04
|
|
|
REPAIR COMPLEX 5CM OR LESS
|
Facility
|
OP
|
$2,133.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.29 |
| Max. Negotiated Rate |
$2,047.68 |
| Rate for Payer: Aetna Commercial |
$1,642.41
|
| Rate for Payer: Anthem Medicaid |
$733.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,663.74
|
| Rate for Payer: Cash Price |
$1,066.50
|
| Rate for Payer: Cigna Commercial |
$1,770.39
|
| Rate for Payer: First Health Commercial |
$2,026.35
|
| Rate for Payer: Humana Commercial |
$1,813.05
|
| Rate for Payer: Humana KY Medicaid |
$733.54
|
| Rate for Payer: Kentucky WC Medicaid |
$741.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,749.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,574.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$639.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$748.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,877.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,599.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$661.23
|
| Rate for Payer: PHCS Commercial |
$2,047.68
|
| Rate for Payer: United Healthcare All Payer |
$1,877.04
|
|
|
REPAIR COMPLEX 5CM OR LESS
|
Professional
|
Both
|
$2,133.00
|
|
|
Service Code
|
HCPCS 13133
|
| Hospital Charge Code |
76100157
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$2,133.00 |
| Rate for Payer: Aetna Commercial |
$195.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$66.24
|
| Rate for Payer: Anthem Medicaid |
$96.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,133.00
|
| Rate for Payer: Cash Price |
$1,066.50
|
| Rate for Payer: Cash Price |
$1,066.50
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Healthspan PPO |
$190.94
|
| Rate for Payer: Humana Medicaid |
$96.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$98.43
|
| Rate for Payer: Molina Healthcare Passport |
$96.50
|
| Rate for Payer: Multiplan PHCS |
$1,279.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,493.10
|
| Rate for Payer: UHCCP Medicaid |
$69.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$97.46
|
|
