|
SKEL FIX FEM FX PROX NECK
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
76100790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$2,592.00 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
SKEL FIX FEM FX PROX NECK
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
76100790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$928.53 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$2,079.00
|
| Rate for Payer: Anthem Medicaid |
$928.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,106.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$2,241.00
|
| Rate for Payer: First Health Commercial |
$2,565.00
|
| Rate for Payer: Humana Commercial |
$2,295.00
|
| Rate for Payer: Humana KY Medicaid |
$928.53
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$937.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,214.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,992.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$947.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,376.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,349.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,863.00
|
| Rate for Payer: PHCS Commercial |
$2,592.00
|
| Rate for Payer: United Healthcare All Payer |
$2,376.00
|
|
|
SKEL FIX FEM FX PROX NECK
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
76100790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.73 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,354.18
|
| Rate for Payer: Ambetter Exchange |
$862.54
|
| Rate for Payer: Anthem Medicaid |
$764.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$862.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,035.05
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,476.56
|
| Rate for Payer: Healthspan PPO |
$1,226.60
|
| Rate for Payer: Humana Medicaid |
$764.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$862.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$780.02
|
| Rate for Payer: Molina Healthcare Passport |
$764.73
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,121.30
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$772.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$862.54
|
|
|
SKEL FIX FEM FX PROX NECK(P
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 27235
|
| Hospital Charge Code |
761P0790
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$764.73 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$1,354.18
|
| Rate for Payer: Ambetter Exchange |
$862.54
|
| Rate for Payer: Anthem Medicaid |
$764.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$862.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$862.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,035.05
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cash Price |
$1,350.00
|
| Rate for Payer: Cigna Commercial |
$1,476.56
|
| Rate for Payer: Healthspan PPO |
$1,226.60
|
| Rate for Payer: Humana Medicaid |
$764.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,136.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$862.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$862.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$780.02
|
| Rate for Payer: Molina Healthcare Passport |
$764.73
|
| Rate for Payer: Multiplan PHCS |
$1,620.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,121.30
|
| Rate for Payer: UHCCP Medicaid |
$945.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$772.38
|
| Rate for Payer: Wellcare Medicare Advantage |
$862.54
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Facility
|
OP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
76100632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$345.62 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem Medicaid |
$345.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Humana KY Medicaid |
$345.62
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$349.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$352.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$693.45
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
76100632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,091.51 |
| Rate for Payer: Aetna Commercial |
$952.28
|
| Rate for Payer: Ambetter Exchange |
$640.12
|
| Rate for Payer: Anthem Medicaid |
$478.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$640.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$768.14
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,091.51
|
| Rate for Payer: Healthspan PPO |
$862.56
|
| Rate for Payer: Humana Medicaid |
$478.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$640.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.14
|
| Rate for Payer: Molina Healthcare Passport |
$478.57
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$832.16
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$640.12
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Facility
|
IP
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
76100632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$301.50 |
| Max. Negotiated Rate |
$964.80 |
| Rate for Payer: Aetna Commercial |
$773.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$783.90
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$834.15
|
| Rate for Payer: First Health Commercial |
$954.75
|
| Rate for Payer: Humana Commercial |
$854.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$824.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$741.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$301.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$884.40
|
| Rate for Payer: Ohio Health Group HMO |
$753.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$693.45
|
| Rate for Payer: PHCS Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Payer |
$884.40
|
|
|
SKEL FIXJ DISTAL RAD FX/EPIPH
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 25606
|
| Hospital Charge Code |
761P0632
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$351.75 |
| Max. Negotiated Rate |
$1,091.51 |
| Rate for Payer: Aetna Commercial |
$952.28
|
| Rate for Payer: Ambetter Exchange |
$640.12
|
| Rate for Payer: Anthem Medicaid |
$478.57
|
| Rate for Payer: Buckeye Individual/Medicaid |
$640.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$768.14
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cash Price |
$502.50
|
| Rate for Payer: Cigna Commercial |
$1,091.51
|
| Rate for Payer: Healthspan PPO |
$862.56
|
| Rate for Payer: Humana Medicaid |
$478.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$817.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$640.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$488.14
|
| Rate for Payer: Molina Healthcare Passport |
$478.57
|
| Rate for Payer: Multiplan PHCS |
$603.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$832.16
|
| Rate for Payer: UHCCP Medicaid |
$351.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$640.12
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
76101024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.32 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
76101024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.60
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
761P1024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.02 |
| Max. Negotiated Rate |
$504.99 |
| Rate for Payer: Aetna Commercial |
$322.55
|
| Rate for Payer: Ambetter Exchange |
$260.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.94
|
| Rate for Payer: Anthem Medicaid |
$127.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$260.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.97
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: Healthspan PPO |
$504.99
|
| Rate for Payer: Humana Medicaid |
$127.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$260.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.56
|
| Rate for Payer: Molina Healthcare Passport |
$127.02
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$339.05
|
| Rate for Payer: UHCCP Medicaid |
$147.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.81
|
|
|
SKEL FIXJ FX GRT TOE PHLX/PHLG
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 28496
|
| Hospital Charge Code |
76101024
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.02 |
| Max. Negotiated Rate |
$504.99 |
| Rate for Payer: Aetna Commercial |
$322.55
|
| Rate for Payer: Ambetter Exchange |
$260.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$140.94
|
| Rate for Payer: Anthem Medicaid |
$127.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$260.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$312.97
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$361.05
|
| Rate for Payer: Healthspan PPO |
$504.99
|
| Rate for Payer: Humana Medicaid |
$127.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$279.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$260.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$260.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$129.56
|
| Rate for Payer: Molina Healthcare Passport |
$127.02
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$339.05
|
| Rate for Payer: UHCCP Medicaid |
$147.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$260.81
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.35 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$1,086.91
|
| Rate for Payer: Ambetter Exchange |
$747.92
|
| Rate for Payer: Anthem Medicaid |
$504.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$747.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$747.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$897.50
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,202.94
|
| Rate for Payer: Healthspan PPO |
$984.51
|
| Rate for Payer: Humana Medicaid |
$504.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$918.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$747.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.44
|
| Rate for Payer: Molina Healthcare Passport |
$504.35
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$972.30
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$747.92
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$567.43 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem Medicaid |
$567.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Humana KY Medicaid |
$567.43
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$573.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$578.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
76100538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$495.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$1,270.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,287.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,369.50
|
| Rate for Payer: First Health Commercial |
$1,567.50
|
| Rate for Payer: Humana Commercial |
$1,402.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,353.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,217.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$495.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,452.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,237.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,435.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,138.50
|
| Rate for Payer: PHCS Commercial |
$1,584.00
|
| Rate for Payer: United Healthcare All Payer |
$1,452.00
|
|
|
SKEL FIX SPRCND/TRANSCND HUMFX
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 24538
|
| Hospital Charge Code |
761P0538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.35 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$1,086.91
|
| Rate for Payer: Ambetter Exchange |
$747.92
|
| Rate for Payer: Anthem Medicaid |
$504.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$747.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$747.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$897.50
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cash Price |
$825.00
|
| Rate for Payer: Cigna Commercial |
$1,202.94
|
| Rate for Payer: Healthspan PPO |
$984.51
|
| Rate for Payer: Humana Medicaid |
$504.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$918.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$747.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$747.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$514.44
|
| Rate for Payer: Molina Healthcare Passport |
$504.35
|
| Rate for Payer: Multiplan PHCS |
$990.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$972.30
|
| Rate for Payer: UHCCP Medicaid |
$577.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$509.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$747.92
|
|
|
SKIN BRACHY LESION OR>2CM
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
333P0047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$552.79 |
| Rate for Payer: Ambetter Exchange |
$330.12
|
| Rate for Payer: Anthem Medicaid |
$261.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.14
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$552.79
|
| Rate for Payer: Humana Medicaid |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.22
|
| Rate for Payer: Molina Healthcare Passport |
$261.98
|
| Rate for Payer: Multiplan PHCS |
$156.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.16
|
| Rate for Payer: UHCCP Medicaid |
$91.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.12
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
IP
|
$4,677.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,403.10 |
| Max. Negotiated Rate |
$4,489.92 |
| Rate for Payer: Aetna Commercial |
$3,601.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.06
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cigna Commercial |
$3,881.91
|
| Rate for Payer: First Health Commercial |
$4,443.15
|
| Rate for Payer: Humana Commercial |
$3,975.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,115.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,068.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,227.13
|
| Rate for Payer: PHCS Commercial |
$4,489.92
|
| Rate for Payer: United Healthcare All Payer |
$4,115.76
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
OP
|
$4,677.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
33300031
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.99 |
| Max. Negotiated Rate |
$4,489.92 |
| Rate for Payer: Aetna Commercial |
$3,601.29
|
| Rate for Payer: Anthem Medicaid |
$1,608.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$242.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$340.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$328.04
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cigna Commercial |
$3,881.91
|
| Rate for Payer: First Health Commercial |
$4,443.15
|
| Rate for Payer: Humana Commercial |
$3,975.45
|
| Rate for Payer: Humana KY Medicaid |
$1,608.42
|
| Rate for Payer: Humana Medicare Advantage |
$242.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,624.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,640.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,115.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,068.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,227.13
|
| Rate for Payer: PHCS Commercial |
$4,489.92
|
| Rate for Payer: United Healthcare All Payer |
$4,115.76
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
IP
|
$4,677.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
333T0047
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$1,403.10 |
| Max. Negotiated Rate |
$4,489.92 |
| Rate for Payer: Aetna Commercial |
$3,601.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.06
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cigna Commercial |
$3,881.91
|
| Rate for Payer: First Health Commercial |
$4,443.15
|
| Rate for Payer: Humana Commercial |
$3,975.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,115.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,068.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,227.13
|
| Rate for Payer: PHCS Commercial |
$4,489.92
|
| Rate for Payer: United Healthcare All Payer |
$4,115.76
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
SKIN BRACHY LESION OR>2CM
|
Professional
|
Both
|
$4,937.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$91.03 |
| Max. Negotiated Rate |
$2,962.20 |
| Rate for Payer: Ambetter Exchange |
$330.12
|
| Rate for Payer: Anthem Medicaid |
$261.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.14
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$552.79
|
| Rate for Payer: Humana Medicaid |
$261.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.03
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.22
|
| Rate for Payer: Molina Healthcare Passport |
$261.98
|
| Rate for Payer: Multiplan PHCS |
$2,962.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.16
|
| Rate for Payer: UHCCP Medicaid |
$1,727.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.12
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
33300047
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$242.99 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$242.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$340.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$328.04
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Humana Medicare Advantage |
$242.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
SKIN BRACHY LESION OR>2CM
|
Facility
|
OP
|
$4,677.00
|
|
|
Service Code
|
HCPCS 77768
|
| Hospital Charge Code |
333T0047
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$242.99 |
| Max. Negotiated Rate |
$4,489.92 |
| Rate for Payer: Aetna Commercial |
$3,601.29
|
| Rate for Payer: Anthem Medicaid |
$1,608.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$242.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$340.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$328.04
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cash Price |
$2,338.50
|
| Rate for Payer: Cigna Commercial |
$3,881.91
|
| Rate for Payer: First Health Commercial |
$4,443.15
|
| Rate for Payer: Humana Commercial |
$3,975.45
|
| Rate for Payer: Humana KY Medicaid |
$1,608.42
|
| Rate for Payer: Humana Medicare Advantage |
$242.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,624.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,451.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$291.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,640.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,115.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,507.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,068.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,227.13
|
| Rate for Payer: PHCS Commercial |
$4,489.92
|
| Rate for Payer: United Healthcare All Payer |
$4,115.76
|
|
|
SKIN BRIGH PROG + TEXT KIT GBL
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
22200153
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$249.60 |
| Rate for Payer: Aetna Commercial |
$200.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.80
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cigna Commercial |
$215.80
|
| Rate for Payer: First Health Commercial |
$247.00
|
| Rate for Payer: Humana Commercial |
$221.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$228.80
|
| Rate for Payer: Ohio Health Group HMO |
$195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.40
|
| Rate for Payer: PHCS Commercial |
$249.60
|
| Rate for Payer: United Healthcare All Payer |
$228.80
|
|
