|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$59,415.19
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$40,317.45 |
| Max. Negotiated Rate |
$59,415.19 |
| Rate for Payer: Anthem Medicaid |
$40,317.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$42,439.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$59,415.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$57,293.22
|
| Rate for Payer: Humana KY Medicaid |
$40,317.45
|
| Rate for Payer: Humana Medicare Advantage |
$42,439.42
|
| Rate for Payer: Kentucky WC Medicaid |
$40,720.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50,927.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$41,123.80
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,685.53
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$12,679.47 |
| Max. Negotiated Rate |
$18,685.53 |
| Rate for Payer: Anthem Medicaid |
$12,679.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,346.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,685.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,018.19
|
| Rate for Payer: Humana KY Medicaid |
$12,679.47
|
| Rate for Payer: Humana Medicare Advantage |
$13,346.81
|
| Rate for Payer: Kentucky WC Medicaid |
$12,806.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,016.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,933.06
|
|
|
STONEMASTER V BD 25MM BALLOON
|
Facility
|
IP
|
$3,859.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.67 |
| Max. Negotiated Rate |
$3,704.64 |
| Rate for Payer: Aetna Commercial |
$2,971.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,010.02
|
| Rate for Payer: Cash Price |
$1,929.50
|
| Rate for Payer: Cigna Commercial |
$3,202.97
|
| Rate for Payer: First Health Commercial |
$3,666.05
|
| Rate for Payer: Humana Commercial |
$3,280.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,164.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,847.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,395.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,894.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,196.29
|
| Rate for Payer: PHCS Commercial |
$3,704.64
|
| Rate for Payer: United Healthcare All Payer |
$3,395.92
|
|
|
STONEMASTER V BD 25MM BALLOON
|
Facility
|
OP
|
$3,859.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.67 |
| Max. Negotiated Rate |
$3,704.64 |
| Rate for Payer: Aetna Commercial |
$2,971.43
|
| Rate for Payer: Anthem Medicaid |
$1,327.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,010.02
|
| Rate for Payer: Cash Price |
$1,929.50
|
| Rate for Payer: Cigna Commercial |
$3,202.97
|
| Rate for Payer: First Health Commercial |
$3,666.05
|
| Rate for Payer: Humana Commercial |
$3,280.15
|
| Rate for Payer: Humana KY Medicaid |
$1,327.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,340.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,164.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,847.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,353.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,395.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,894.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,196.29
|
| Rate for Payer: PHCS Commercial |
$3,704.64
|
| Rate for Payer: United Healthcare All Payer |
$3,395.92
|
|
|
STOOL SPEC FAT STAIN
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 89125
|
| Hospital Charge Code |
30001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.88
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$19.60
|
| Rate for Payer: Humana Medicare Advantage |
$5.88
|
| Rate for Payer: Kentucky WC Medicaid |
$19.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
STOOL SPEC FAT STAIN
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 89125
|
| Hospital Charge Code |
30001549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.77
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
STRAIGHT GC 7F 90CM
|
Facility
|
IP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
STRAIGHT GC 7F 90CM
|
Facility
|
OP
|
$1,090.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$1,047.17 |
| Rate for Payer: Aetna Commercial |
$839.92
|
| Rate for Payer: Anthem Medicaid |
$375.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.82
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$905.36
|
| Rate for Payer: First Health Commercial |
$1,036.26
|
| Rate for Payer: Humana Commercial |
$927.18
|
| Rate for Payer: Humana KY Medicaid |
$375.13
|
| Rate for Payer: Kentucky WC Medicaid |
$378.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$959.90
|
| Rate for Payer: Ohio Health Group HMO |
$818.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.15
|
| Rate for Payer: PHCS Commercial |
$1,047.17
|
| Rate for Payer: United Healthcare All Payer |
$959.90
|
|
|
STRAIGHT GUIDE 6F 90CM
|
Facility
|
IP
|
$1,755.65
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$1,685.42 |
| Rate for Payer: Aetna Commercial |
$1,351.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.41
|
| Rate for Payer: Cash Price |
$877.82
|
| Rate for Payer: Cigna Commercial |
$1,457.19
|
| Rate for Payer: First Health Commercial |
$1,667.87
|
| Rate for Payer: Humana Commercial |
$1,492.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.25
|
| Rate for Payer: PHCS Commercial |
$1,685.42
|
| Rate for Payer: United Healthcare All Payer |
$1,544.97
|
|
|
STRAIGHT GUIDE 6F 90CM
|
Facility
|
OP
|
$1,755.65
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.23 |
| Max. Negotiated Rate |
$1,685.42 |
| Rate for Payer: Aetna Commercial |
$1,351.85
|
| Rate for Payer: Anthem Medicaid |
$603.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.41
|
| Rate for Payer: Cash Price |
$877.82
|
| Rate for Payer: Cigna Commercial |
$1,457.19
|
| Rate for Payer: First Health Commercial |
$1,667.87
|
| Rate for Payer: Humana Commercial |
$1,492.30
|
| Rate for Payer: Humana KY Medicaid |
$603.77
|
| Rate for Payer: Kentucky WC Medicaid |
$609.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$615.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,544.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,316.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$544.25
|
| Rate for Payer: PHCS Commercial |
$1,685.42
|
| Rate for Payer: United Healthcare All Payer |
$1,544.97
|
|
|
STRAIGHT PIGTAIL 125CM
|
Facility
|
IP
|
$167.28
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$160.59 |
| Rate for Payer: Aetna Commercial |
$128.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.48
|
| Rate for Payer: Cash Price |
$83.64
|
| Rate for Payer: Cigna Commercial |
$138.84
|
| Rate for Payer: First Health Commercial |
$158.92
|
| Rate for Payer: Humana Commercial |
$142.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.21
|
| Rate for Payer: Ohio Health Group HMO |
$125.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.86
|
| Rate for Payer: PHCS Commercial |
$160.59
|
| Rate for Payer: United Healthcare All Payer |
$147.21
|
|
|
STRAIGHT PIGTAIL 125CM
|
Facility
|
OP
|
$167.28
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$160.59 |
| Rate for Payer: Aetna Commercial |
$128.81
|
| Rate for Payer: Anthem Medicaid |
$57.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.48
|
| Rate for Payer: Cash Price |
$83.64
|
| Rate for Payer: Cigna Commercial |
$138.84
|
| Rate for Payer: First Health Commercial |
$158.92
|
| Rate for Payer: Humana Commercial |
$142.19
|
| Rate for Payer: Humana KY Medicaid |
$57.53
|
| Rate for Payer: Kentucky WC Medicaid |
$58.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.21
|
| Rate for Payer: Ohio Health Group HMO |
$125.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.86
|
| Rate for Payer: PHCS Commercial |
$160.59
|
| Rate for Payer: United Healthcare All Payer |
$147.21
|
|
|
STRAIGHT QUICK CROSS GC 0.035
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
STRAIGHT QUICK CROSS GC 0.035
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.75 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.25
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
STRAPPING ANKLE AND OR FOOT ED
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
76101068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$190.76 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
STRAPPING ANKLE AND OR FOOT ED
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
76101068
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
STRAPPING ANKLE AND OR FOOT ED
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
45000203
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
STRAPPING ANKLE AND OR FOOT ED
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
45000203
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
76101057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
45000194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Humana KY Medicaid |
$18.57
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$18.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
76101057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
45000194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
STRAPPING HAND OR FINGER
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
45000195
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$44.82
|
| Rate for Payer: First Health Commercial |
$51.30
|
| Rate for Payer: Humana Commercial |
$45.90
|
| Rate for Payer: Humana KY Medicaid |
$18.57
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$18.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$44.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$47.52
|
| Rate for Payer: Ohio Health Group HMO |
$40.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.74
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
STRAPPING HAND OR FINGER
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
76101058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
76101058
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
