|
STRAIGHT PIGTAIL 125CM
|
Facility
|
IP
|
$171.52
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$164.66 |
| Rate for Payer: Aetna Commercial |
$132.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.79
|
| Rate for Payer: Cash Price |
$85.76
|
| Rate for Payer: Cigna Commercial |
$142.36
|
| Rate for Payer: First Health Commercial |
$162.94
|
| Rate for Payer: Humana Commercial |
$145.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.94
|
| Rate for Payer: Ohio Health Group HMO |
$128.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.35
|
| Rate for Payer: PHCS Commercial |
$164.66
|
| Rate for Payer: United Healthcare All Payer |
$150.94
|
|
|
STRAIGHT PIGTAIL 125CM
|
Facility
|
OP
|
$171.52
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.46 |
| Max. Negotiated Rate |
$164.66 |
| Rate for Payer: Aetna Commercial |
$132.07
|
| Rate for Payer: Anthem Medicaid |
$58.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.79
|
| Rate for Payer: Cash Price |
$85.76
|
| Rate for Payer: Cigna Commercial |
$142.36
|
| Rate for Payer: First Health Commercial |
$162.94
|
| Rate for Payer: Humana Commercial |
$145.79
|
| Rate for Payer: Humana KY Medicaid |
$58.99
|
| Rate for Payer: Kentucky WC Medicaid |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.94
|
| Rate for Payer: Ohio Health Group HMO |
$128.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.35
|
| Rate for Payer: PHCS Commercial |
$164.66
|
| Rate for Payer: United Healthcare All Payer |
$150.94
|
|
|
STRAIGHT QUICK CROSS GC 0.035
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem Medicaid |
$643.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Humana KY Medicaid |
$643.09
|
| Rate for Payer: Kentucky WC Medicaid |
$649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
STRAIGHT QUICK CROSS GC 0.035
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$1,795.20 |
| Rate for Payer: Aetna Commercial |
$1,439.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.60
|
| Rate for Payer: Cash Price |
$935.00
|
| Rate for Payer: Cigna Commercial |
$1,552.10
|
| Rate for Payer: First Health Commercial |
$1,776.50
|
| Rate for Payer: Humana Commercial |
$1,589.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,533.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,380.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.30
|
| Rate for Payer: PHCS Commercial |
$1,795.20
|
| Rate for Payer: United Healthcare All Payer |
$1,645.60
|
|
|
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 |
$66.03 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| 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 |
$145.79
|
| 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 |
$174.95
|
| 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 |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| 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 |
$57.60 |
| 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 |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
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 |
$71.88 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| 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 |
$145.79
|
| 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 |
$174.95
|
| 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 |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
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 |
$62.70 |
| 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 |
$167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.21
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
76101057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| 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 |
$16.20 |
| 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 |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
45000194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.57 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| Rate for Payer: PHCS Commercial |
$51.84
|
| Rate for Payer: United Healthcare All Payer |
$47.52
|
|
|
STRAPPING ELBOW OR WRIST
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 29260
|
| Hospital Charge Code |
76101057
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.60 |
| 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 |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
STRAPPING HAND OR FINGER
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS 29280
|
| Hospital Charge Code |
45000195
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.20 |
| 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 |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| 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 |
$18.57 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$41.58
|
| Rate for Payer: Anthem Medicaid |
$18.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.26
|
| 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 |
$17.88 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| 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 |
$15.60 |
| 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 |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
STRAPPING HIP
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
45000201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$27.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$27.86
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$28.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
STRAPPING HIP
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
76101066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
STRAPPING HIP
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
45000201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
STRAPPING HIP
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 29520
|
| Hospital Charge Code |
76101066
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
STRAPPING KNEE
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
76101067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem Medicaid |
$63.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Humana KY Medicaid |
$63.28
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.96
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
STRAPPING KNEE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
45000202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
STRAPPING KNEE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
45000202
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
STRAPPING KNEE
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 29530
|
| Hospital Charge Code |
76101067
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$141.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.52
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: First Health Commercial |
$174.80
|
| Rate for Payer: Humana Commercial |
$156.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.92
|
| Rate for Payer: Ohio Health Group HMO |
$138.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.96
|
| Rate for Payer: PHCS Commercial |
$176.64
|
| Rate for Payer: United Healthcare All Payer |
$161.92
|
|
|
STRAPPING REHAB
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
42000065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
