|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
45000168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.43 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.41
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
76100940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.22 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$612.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$274.22
|
| Rate for Payer: Anthem Medicaid |
$296.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,056.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$677.82
|
| Rate for Payer: Healthspan PPO |
$597.70
|
| Rate for Payer: Humana Medicaid |
$296.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.26
|
| Rate for Payer: Molina Healthcare Passport |
$296.33
|
| Rate for Payer: Multiplan PHCS |
$633.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.20
|
| Rate for Payer: UHCCP Medicaid |
$287.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.29
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
76101014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
TREATMENT OF ANKLE FRACTURE
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
76100939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
TREATMENT OF ANKLE FRACTURE(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
761P0939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$159.36 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$159.36
|
| Rate for Payer: Anthem Medicaid |
$161.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$497.32
|
| Rate for Payer: Healthspan PPO |
$399.01
|
| Rate for Payer: Humana Medicaid |
$161.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$354.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.71
|
| Rate for Payer: Molina Healthcare Passport |
$161.48
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$167.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.09
|
|
|
TREATMENT OF ANKLE FRACTURE(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
761P1014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$98.87 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$281.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$131.80
|
| Rate for Payer: Anthem Medicaid |
$98.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$355.57
|
| Rate for Payer: Healthspan PPO |
$283.14
|
| Rate for Payer: Humana Medicaid |
$98.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$247.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.85
|
| Rate for Payer: Molina Healthcare Passport |
$98.87
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$138.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.86
|
|
|
TREATMENT OF ANKLE FRACTURE(P
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 27810
|
| Hospital Charge Code |
761P0940
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$274.22 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$612.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$274.22
|
| Rate for Payer: Anthem Medicaid |
$296.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,056.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cigna Commercial |
$677.82
|
| Rate for Payer: Healthspan PPO |
$597.70
|
| Rate for Payer: Humana Medicaid |
$296.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$302.26
|
| Rate for Payer: Molina Healthcare Passport |
$296.33
|
| Rate for Payer: Multiplan PHCS |
$633.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$739.20
|
| Rate for Payer: UHCCP Medicaid |
$287.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$299.29
|
|
|
TREATMENT OF BURN
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
76102552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TREATMENT OF BURN
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
45000325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.49
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
TREATMENT OF BURN
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
45000325
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$61.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$61.56
|
| Rate for Payer: Kentucky WC Medicaid |
$62.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.49
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
TREATMENT OF BURN
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
76102552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.32
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
76101011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
76101011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
TREATMENT OF HEEL FRACTURE
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
76101011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$378.43
|
| Rate for Payer: Healthspan PPO |
$302.99
|
| Rate for Payer: Humana Medicaid |
$103.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.23
|
| Rate for Payer: Molina Healthcare Passport |
$103.17
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.20
|
|
|
TREATMENT OF HEEL FRACTURE(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
761P1011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$378.43
|
| Rate for Payer: Healthspan PPO |
$302.99
|
| Rate for Payer: Humana Medicaid |
$103.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$105.23
|
| Rate for Payer: Molina Healthcare Passport |
$103.17
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$104.20
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$3,784.94
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,703.53 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
|
|
TREATMENT OF PENIS LESION
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
76102784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.66 |
| Max. Negotiated Rate |
$530.00 |
| Rate for Payer: Aetna Commercial |
$134.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.35
|
| Rate for Payer: Anthem Medicaid |
$34.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$530.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$163.82
|
| Rate for Payer: Healthspan PPO |
$167.97
|
| Rate for Payer: Humana Medicaid |
$34.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.35
|
| Rate for Payer: Molina Healthcare Passport |
$34.66
|
| Rate for Payer: Multiplan PHCS |
$318.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$371.00
|
| Rate for Payer: UHCCP Medicaid |
$58.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.01
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
76102784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
76102784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$68.90 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$408.10
|
| Rate for Payer: Anthem Medicaid |
$182.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cash Price |
$265.00
|
| Rate for Payer: Cigna Commercial |
$439.90
|
| Rate for Payer: First Health Commercial |
$503.50
|
| Rate for Payer: Humana Commercial |
$450.50
|
| Rate for Payer: Humana KY Medicaid |
$182.27
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$185.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.40
|
| Rate for Payer: Ohio Health Group HMO |
$397.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$164.30
|
| Rate for Payer: PHCS Commercial |
$508.80
|
| Rate for Payer: United Healthcare All Payer |
$466.40
|
|
|
TREATMENT OF PENIS LESION (P
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
761P2784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.66 |
| Max. Negotiated Rate |
$167.97 |
| Rate for Payer: Aetna Commercial |
$134.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.35
|
| Rate for Payer: Anthem Medicaid |
$34.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$163.82
|
| Rate for Payer: Healthspan PPO |
$167.97
|
| Rate for Payer: Humana Medicaid |
$34.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.35
|
| Rate for Payer: Molina Healthcare Passport |
$34.66
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.50
|
| Rate for Payer: UHCCP Medicaid |
$58.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$35.01
|
|
|
TREATMENT OF PENIS LESION (T
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
761T2784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem Medicaid |
$135.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$213.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$299.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$288.52
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Humana KY Medicaid |
$135.84
|
| Rate for Payer: Humana Medicare Advantage |
$213.72
|
| Rate for Payer: Kentucky WC Medicaid |
$137.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.45
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
TREATMENT OF PENIS LESION (T
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
761T2784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$379.20 |
| Rate for Payer: Aetna Commercial |
$304.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.10
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$327.85
|
| Rate for Payer: First Health Commercial |
$375.25
|
| Rate for Payer: Humana Commercial |
$335.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$323.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$291.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$347.60
|
| Rate for Payer: Ohio Health Group HMO |
$296.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.45
|
| Rate for Payer: PHCS Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Payer |
$347.60
|
|
|
TREATMENT OF SWALLOWING
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
44000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.70
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
TREATMENT OF SWALLOWING
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
44000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$56.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.70
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$56.74
|
| Rate for Payer: Kentucky WC Medicaid |
$57.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.15
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
