|
REPR CAROTID W GRFT
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
76101355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR CAROTID W GRFT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
76101355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.74 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,108.22
|
| Rate for Payer: Anthem Medicaid |
$967.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,013.85
|
| Rate for Payer: Healthspan PPO |
$2,072.79
|
| Rate for Payer: Humana Medicaid |
$967.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,578.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.09
|
| Rate for Payer: Molina Healthcare Passport |
$967.74
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.42
|
|
|
REPR CAROTID W GRFT
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
76101355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem Medicaid |
$1,100.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
|
REPR CAROTID W GRFT(P
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 35002
|
| Hospital Charge Code |
761P1355
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$967.74 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$2,108.22
|
| Rate for Payer: Anthem Medicaid |
$967.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,200.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,013.85
|
| Rate for Payer: Healthspan PPO |
$2,072.79
|
| Rate for Payer: Humana Medicaid |
$967.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,578.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$987.09
|
| Rate for Payer: Molina Healthcare Passport |
$967.74
|
| Rate for Payer: Multiplan PHCS |
$1,920.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,240.00
|
| Rate for Payer: UHCCP Medicaid |
$1,120.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$977.42
|
|
|
REPR - COMPLEX EACH ADD 5 CM
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$2,265.00 |
| Rate for Payer: Aetna Commercial |
$213.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.46
|
| Rate for Payer: Anthem Medicaid |
$106.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,265.00
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cigna Commercial |
$201.16
|
| Rate for Payer: Healthspan PPO |
$210.83
|
| Rate for Payer: Humana Medicaid |
$106.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.18
|
| Rate for Payer: Molina Healthcare Passport |
$106.06
|
| Rate for Payer: Multiplan PHCS |
$1,359.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,585.50
|
| Rate for Payer: UHCCP Medicaid |
$75.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.12
|
|
|
REPR - COMPLEX EACH ADD 5 CM
|
Facility
|
IP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.45 |
| Max. Negotiated Rate |
$2,174.40 |
| Rate for Payer: Aetna Commercial |
$1,744.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,766.70
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cigna Commercial |
$1,879.95
|
| Rate for Payer: First Health Commercial |
$2,151.75
|
| Rate for Payer: Humana Commercial |
$1,925.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,857.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,671.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,993.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,698.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$702.15
|
| Rate for Payer: PHCS Commercial |
$2,174.40
|
| Rate for Payer: United Healthcare All Payer |
$1,993.20
|
|
|
REPR - COMPLEX EACH ADD 5 CM
|
Facility
|
OP
|
$2,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
76100160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.45 |
| Max. Negotiated Rate |
$2,174.40 |
| Rate for Payer: Aetna Commercial |
$1,744.05
|
| Rate for Payer: Anthem Medicaid |
$778.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,766.70
|
| Rate for Payer: Cash Price |
$1,132.50
|
| Rate for Payer: Cigna Commercial |
$1,879.95
|
| Rate for Payer: First Health Commercial |
$2,151.75
|
| Rate for Payer: Humana Commercial |
$1,925.25
|
| Rate for Payer: Humana KY Medicaid |
$778.93
|
| Rate for Payer: Kentucky WC Medicaid |
$786.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,857.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,671.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$679.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$794.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,993.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,698.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$453.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$294.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$702.15
|
| Rate for Payer: PHCS Commercial |
$2,174.40
|
| Rate for Payer: United Healthcare All Payer |
$1,993.20
|
|
|
REPR - COMPLEX EACH ADD 5 CM(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
761P0160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.46 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$213.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$71.46
|
| Rate for Payer: Anthem Medicaid |
$106.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$201.16
|
| Rate for Payer: Healthspan PPO |
$210.83
|
| Rate for Payer: Humana Medicaid |
$106.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$181.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$108.18
|
| Rate for Payer: Molina Healthcare Passport |
$106.06
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$75.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$107.12
|
|
|
REPR - COMPLEX EACH ADD 5 CM(T
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
761T0160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$974.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$986.70
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,049.95
|
| Rate for Payer: First Health Commercial |
$1,201.75
|
| Rate for Payer: Humana Commercial |
$1,075.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,037.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$933.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,113.20
|
| Rate for Payer: Ohio Health Group HMO |
$948.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.15
|
| Rate for Payer: PHCS Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Payer |
$1,113.20
|
|
|
REPR - COMPLEX EACH ADD 5 CM(T
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
HCPCS 13153
|
| Hospital Charge Code |
761T0160
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.45 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$974.05
|
| Rate for Payer: Anthem Medicaid |
$435.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$986.70
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cigna Commercial |
$1,049.95
|
| Rate for Payer: First Health Commercial |
$1,201.75
|
| Rate for Payer: Humana Commercial |
$1,075.25
|
| Rate for Payer: Humana KY Medicaid |
$435.03
|
| Rate for Payer: Kentucky WC Medicaid |
$439.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,037.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$933.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$443.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,113.20
|
| Rate for Payer: Ohio Health Group HMO |
$948.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.15
|
| Rate for Payer: PHCS Commercial |
$1,214.40
|
| Rate for Payer: United Healthcare All Payer |
$1,113.20
|
|
|
REPR ELBOW LAT LIGMNT W/TIS(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
761P0522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.35 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,018.43
|
| Rate for Payer: Anthem Medicaid |
$483.35
|
| 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 |
$1,122.74
|
| Rate for Payer: Healthspan PPO |
$922.48
|
| Rate for Payer: Humana Medicaid |
$483.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.02
|
| Rate for Payer: Molina Healthcare Passport |
$483.35
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.18
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
76100522
|
|
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
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| 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 |
$2,799.07
|
| 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 |
$3,358.88
|
| 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
|
|
|
REPR ELBOW LAT LIGMNT W/TISS
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 24343
|
| Hospital Charge Code |
76100522
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.35 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$1,018.43
|
| Rate for Payer: Anthem Medicaid |
$483.35
|
| 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 |
$1,122.74
|
| Rate for Payer: Healthspan PPO |
$922.48
|
| Rate for Payer: Humana Medicaid |
$483.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$865.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$493.02
|
| Rate for Payer: Molina Healthcare Passport |
$483.35
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$488.18
|
|
|
REPR INIT INGIN HERNIA > 5YR
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
76102012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.04 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$738.57
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Healthspan PPO |
$622.85
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
|
|
REPR INIT INGIN HERNIA > 5YR
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
76102012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$4,188.46 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,991.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,188.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,038.88
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$2,991.76
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,590.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REPR INIT INGIN HERNIA > 5YR
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
76102012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
REPR INIT INGIN HERNIA > 5YR(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
761P2012
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$350.04 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$738.57
|
| Rate for Payer: Anthem Medicaid |
$350.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Healthspan PPO |
$622.85
|
| Rate for Payer: Humana Medicaid |
$350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$357.04
|
| Rate for Payer: Molina Healthcare Passport |
$350.04
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$353.54
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
45000065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$911.04 |
| Rate for Payer: Aetna Commercial |
$730.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$740.22
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cigna Commercial |
$787.67
|
| Rate for Payer: First Health Commercial |
$901.55
|
| Rate for Payer: Humana Commercial |
$806.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$700.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$284.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$835.12
|
| Rate for Payer: Ohio Health Group HMO |
$711.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.19
|
| Rate for Payer: PHCS Commercial |
$911.04
|
| Rate for Payer: United Healthcare All Payer |
$835.12
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
45000065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$482.75 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem Medicaid |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Humana KY Medicaid |
$171.61
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$173.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.37 |
| Max. Negotiated Rate |
$911.04 |
| Rate for Payer: Aetna Commercial |
$730.73
|
| Rate for Payer: Anthem Medicaid |
$326.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$344.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$740.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$482.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$465.51
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cigna Commercial |
$787.67
|
| Rate for Payer: First Health Commercial |
$901.55
|
| Rate for Payer: Humana Commercial |
$806.65
|
| Rate for Payer: Humana KY Medicaid |
$326.36
|
| Rate for Payer: Humana Medicare Advantage |
$344.82
|
| Rate for Payer: Kentucky WC Medicaid |
$329.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$778.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$700.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$413.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$835.12
|
| Rate for Payer: Ohio Health Group HMO |
$711.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$123.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.19
|
| Rate for Payer: PHCS Commercial |
$911.04
|
| Rate for Payer: United Healthcare All Payer |
$835.12
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
761P0143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$256.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.48
|
| Rate for Payer: Anthem Medicaid |
$86.99
|
| 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 |
$335.48
|
| Rate for Payer: Healthspan PPO |
$292.38
|
| Rate for Payer: Humana Medicaid |
$86.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$226.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.73
|
| Rate for Payer: Molina Healthcare Passport |
$86.99
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.00
|
| Rate for Payer: UHCCP Medicaid |
$89.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.86
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Professional
|
Both
|
$949.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Aetna Commercial |
$256.47
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.48
|
| Rate for Payer: Anthem Medicaid |
$86.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$949.00
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cash Price |
$474.50
|
| Rate for Payer: Cigna Commercial |
$335.48
|
| Rate for Payer: Healthspan PPO |
$292.38
|
| Rate for Payer: Humana Medicaid |
$86.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$226.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.73
|
| Rate for Payer: Molina Healthcare Passport |
$86.99
|
| Rate for Payer: Multiplan PHCS |
$569.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$664.30
|
| Rate for Payer: UHCCP Medicaid |
$89.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$87.86
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
761T0143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$64.87 |
| Max. Negotiated Rate |
$479.04 |
| Rate for Payer: Aetna Commercial |
$384.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$389.22
|
| Rate for Payer: Cash Price |
$249.50
|
| Rate for Payer: Cigna Commercial |
$414.17
|
| Rate for Payer: First Health Commercial |
$474.05
|
| Rate for Payer: Humana Commercial |
$424.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$409.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$368.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$439.12
|
| Rate for Payer: Ohio Health Group HMO |
$374.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$99.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$64.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.69
|
| Rate for Payer: PHCS Commercial |
$479.04
|
| Rate for Payer: United Healthcare All Payer |
$439.12
|
|
