|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
761T0143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.37 |
| Max. Negotiated Rate |
$941.76 |
| Rate for Payer: Aetna Commercial |
$755.37
|
| Rate for Payer: Anthem Medicaid |
$337.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$814.23
|
| Rate for Payer: First Health Commercial |
$931.95
|
| Rate for Payer: Humana Commercial |
$833.85
|
| Rate for Payer: Humana KY Medicaid |
$337.37
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$340.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$804.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$863.28
|
| Rate for Payer: Ohio Health Group HMO |
$735.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.89
|
| Rate for Payer: PHCS Commercial |
$941.76
|
| Rate for Payer: United Healthcare All Payer |
$863.28
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
76100143
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.48 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Aetna Commercial |
$256.47
|
| Rate for Payer: Ambetter Exchange |
$158.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$85.48
|
| Rate for Payer: Anthem Medicaid |
$100.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$158.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$158.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$189.77
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$335.48
|
| Rate for Payer: Healthspan PPO |
$292.38
|
| Rate for Payer: Humana Medicaid |
$100.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$226.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$158.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.54
|
| Rate for Payer: Molina Healthcare Passport |
$100.53
|
| Rate for Payer: Multiplan PHCS |
$588.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$205.58
|
| Rate for Payer: UHCCP Medicaid |
$89.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$158.14
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
45000065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR INTEMED WOUNDS FACE 2.5 C
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 12051
|
| Hospital Charge Code |
45000065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR INTERMED FACE 2.6-5.0 CM
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR INTERMED FACE 2.6-5.0 CM
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.30 |
| Max. Negotiated Rate |
$941.76 |
| Rate for Payer: Aetna Commercial |
$755.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.18
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$814.23
|
| Rate for Payer: First Health Commercial |
$931.95
|
| Rate for Payer: Humana Commercial |
$833.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$804.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$863.28
|
| Rate for Payer: Ohio Health Group HMO |
$735.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.89
|
| Rate for Payer: PHCS Commercial |
$941.76
|
| Rate for Payer: United Healthcare All Payer |
$863.28
|
|
|
REPR INTERMED FACE 2.6-5.0 CM
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$337.37 |
| Max. Negotiated Rate |
$941.76 |
| Rate for Payer: Aetna Commercial |
$755.37
|
| Rate for Payer: Anthem Medicaid |
$337.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$765.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$814.23
|
| Rate for Payer: First Health Commercial |
$931.95
|
| Rate for Payer: Humana Commercial |
$833.85
|
| Rate for Payer: Humana KY Medicaid |
$337.37
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$340.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$804.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$344.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$863.28
|
| Rate for Payer: Ohio Health Group HMO |
$735.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.89
|
| Rate for Payer: PHCS Commercial |
$941.76
|
| Rate for Payer: United Healthcare All Payer |
$863.28
|
|
|
REPR INTERMED FACE 2.6-5.0 CM
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
45000066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR INTERMED FACE 2.6-5.0 CM
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
76100144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Aetna Commercial |
$298.50
|
| Rate for Payer: Ambetter Exchange |
$187.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.53
|
| Rate for Payer: Anthem Medicaid |
$122.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.45
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cash Price |
$490.50
|
| Rate for Payer: Cigna Commercial |
$359.71
|
| Rate for Payer: Healthspan PPO |
$329.83
|
| Rate for Payer: Humana Medicaid |
$122.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.09
|
| Rate for Payer: Molina Healthcare Passport |
$122.64
|
| Rate for Payer: Multiplan PHCS |
$588.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.15
|
| Rate for Payer: UHCCP Medicaid |
$105.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.04
|
|
|
REPR INTERMED FACE 2.6-5.0 C(P
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
761P0144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$359.71 |
| Rate for Payer: Aetna Commercial |
$298.50
|
| Rate for Payer: Ambetter Exchange |
$187.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$100.53
|
| Rate for Payer: Anthem Medicaid |
$122.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$187.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.45
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$359.71
|
| Rate for Payer: Healthspan PPO |
$329.83
|
| Rate for Payer: Humana Medicaid |
$122.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$269.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$187.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$187.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.09
|
| Rate for Payer: Molina Healthcare Passport |
$122.64
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$243.15
|
| Rate for Payer: UHCCP Medicaid |
$105.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$187.04
|
|
|
REPR INTERMED FACE 2.6-5.0 C(T
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
761T0144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.61 |
| Max. Negotiated Rate |
$516.82 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$369.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$516.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$498.37
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Humana Medicare Advantage |
$369.16
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR INTERMED FACE 2.6-5.0 C(T
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 12052
|
| Hospital Charge Code |
761T0144
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
REPR LAC 2.5<FLRMOUTPOST2/3TNG
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
76101662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
REPR LAC 2.5<FLRMOUTPOST2/3TNG
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
45000253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
REPR LAC 2.5<FLRMOUTPOST2/3TNG
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
45000253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
REPR LAC 2.5<FLRMOUTPOST2/3TNG
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
HCPCS 41251
|
| Hospital Charge Code |
76101662
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.42 |
| Max. Negotiated Rate |
$300.40 |
| Rate for Payer: Aetna Commercial |
$224.84
|
| Rate for Payer: Anthem Medicaid |
$100.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$214.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$227.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$300.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$289.67
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cash Price |
$146.00
|
| Rate for Payer: Cigna Commercial |
$242.36
|
| Rate for Payer: First Health Commercial |
$277.40
|
| Rate for Payer: Humana Commercial |
$248.20
|
| Rate for Payer: Humana KY Medicaid |
$100.42
|
| Rate for Payer: Humana Medicare Advantage |
$214.57
|
| Rate for Payer: Kentucky WC Medicaid |
$101.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$239.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$215.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$257.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.96
|
| Rate for Payer: Ohio Health Group HMO |
$219.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.48
|
| Rate for Payer: PHCS Commercial |
$280.32
|
| Rate for Payer: United Healthcare All Payer |
$256.96
|
|
|
REPR LAC VESTIBLEMOUT>2.5 COMP
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
HCPCS 40831
|
| Hospital Charge Code |
76101642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.90 |
| Max. Negotiated Rate |
$607.68 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
REPR LAC VESTIBLEMOUT>2.5 COMP
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
HCPCS 40831
|
| Hospital Charge Code |
45000250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
REPR LAC VESTIBLEMOUT>2.5 COMP
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
HCPCS 40831
|
| Hospital Charge Code |
45000250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.97 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$508.20
|
| Rate for Payer: Anthem Medicaid |
$226.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$514.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$547.80
|
| Rate for Payer: First Health Commercial |
$627.00
|
| Rate for Payer: Humana Commercial |
$561.00
|
| Rate for Payer: Humana KY Medicaid |
$226.97
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$229.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$541.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$487.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$231.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$580.80
|
| Rate for Payer: Ohio Health Group HMO |
$495.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.40
|
| Rate for Payer: PHCS Commercial |
$633.60
|
| Rate for Payer: United Healthcare All Payer |
$580.80
|
|
|
REPR LAC VESTIBLEMOUT>2.5 COMP
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
HCPCS 40831
|
| Hospital Charge Code |
76101642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$217.69 |
| Max. Negotiated Rate |
$658.76 |
| Rate for Payer: Aetna Commercial |
$487.41
|
| Rate for Payer: Anthem Medicaid |
$217.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$493.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$525.39
|
| Rate for Payer: First Health Commercial |
$601.35
|
| Rate for Payer: Humana Commercial |
$538.05
|
| Rate for Payer: Humana KY Medicaid |
$217.69
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.04
|
| Rate for Payer: Ohio Health Group HMO |
$474.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$506.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$550.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$436.77
|
| Rate for Payer: PHCS Commercial |
$607.68
|
| Rate for Payer: United Healthcare All Payer |
$557.04
|
|
|
REPR OF ANAL FISTULA W/GLUE
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 46706
|
| Hospital Charge Code |
76101933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$237.21
|
| Rate for Payer: Ambetter Exchange |
$172.17
|
| Rate for Payer: Anthem Medicaid |
$105.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.60
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$215.67
|
| Rate for Payer: Healthspan PPO |
$200.04
|
| Rate for Payer: Humana Medicaid |
$105.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.17
|
| Rate for Payer: Molina Healthcare Passport |
$105.07
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.82
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.17
|
|
|
REPR OF ANAL FISTULA W/GLUE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
HCPCS 46706
|
| Hospital Charge Code |
76101933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
REPR OF ANAL FISTULA W/GLUE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
HCPCS 46706
|
| Hospital Charge Code |
76101933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.56 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Humana Medicare Advantage |
$2,533.91
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,040.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
REPR OF ANAL FISTULA W/GLUE(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 46706
|
| Hospital Charge Code |
761P1933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.07 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$237.21
|
| Rate for Payer: Ambetter Exchange |
$172.17
|
| Rate for Payer: Anthem Medicaid |
$105.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$172.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$172.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$206.60
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$215.67
|
| Rate for Payer: Healthspan PPO |
$200.04
|
| Rate for Payer: Humana Medicaid |
$105.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$209.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$172.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$172.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.17
|
| Rate for Payer: Molina Healthcare Passport |
$105.07
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$223.82
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$172.17
|
|
