|
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 |
$497.32 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Ambetter Exchange |
$295.96
|
| 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 Individual/Medicaid |
$295.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$355.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$295.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.96
|
| 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 |
$384.75
|
| Rate for Payer: UHCCP Medicaid |
$167.33
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$295.96
|
|
|
TREATMENT OF ANKLE FRACTURE(T
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
761T0939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.24 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem Medicaid |
$203.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Humana KY Medicaid |
$203.24
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$205.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.79
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
TREATMENT OF ANKLE FRACTURE(T
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
761T1014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$586.56 |
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.58
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$507.13
|
| Rate for Payer: First Health Commercial |
$580.45
|
| Rate for Payer: Humana Commercial |
$519.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.68
|
| Rate for Payer: Ohio Health Group HMO |
$458.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.59
|
| Rate for Payer: PHCS Commercial |
$586.56
|
| Rate for Payer: United Healthcare All Payer |
$537.68
|
|
|
TREATMENT OF ANKLE FRACTURE(T
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
HCPCS 28430
|
| Hospital Charge Code |
761T1014
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.12 |
| Max. Negotiated Rate |
$586.56 |
| Rate for Payer: Aetna Commercial |
$470.47
|
| Rate for Payer: Anthem Medicaid |
$210.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$476.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cash Price |
$305.50
|
| Rate for Payer: Cigna Commercial |
$507.13
|
| Rate for Payer: First Health Commercial |
$580.45
|
| Rate for Payer: Humana Commercial |
$519.35
|
| Rate for Payer: Humana KY Medicaid |
$210.12
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$212.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$501.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$450.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$214.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$537.68
|
| Rate for Payer: Ohio Health Group HMO |
$458.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$421.59
|
| Rate for Payer: PHCS Commercial |
$586.56
|
| Rate for Payer: United Healthcare All Payer |
$537.68
|
|
|
TREATMENT OF ANKLE FRACTURE(T
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS 27808
|
| Hospital Charge Code |
761T0939
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.30 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$472.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$407.79
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
TREATMENT OF BURN
|
Facility
|
OP
|
$172.00
|
|
| Hospital Charge Code |
76102552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.60 |
| 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 |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
TREATMENT OF BURN
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
76102552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$51.60 |
| 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 |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| 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 |
$53.70 |
| 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 |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| 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 |
$53.70 |
| 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 |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
TREATMENT OF HEEL FRACTURE
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
76101011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.63 |
| Max. Negotiated Rate |
$693.60 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Ambetter Exchange |
$220.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$137.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.64
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cigna Commercial |
$378.43
|
| Rate for Payer: Healthspan PPO |
$302.99
|
| Rate for Payer: Humana Medicaid |
$137.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.38
|
| Rate for Payer: Molina Healthcare Passport |
$137.63
|
| Rate for Payer: Multiplan PHCS |
$693.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$286.69
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.53
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
76101011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$221.64 |
| Max. Negotiated Rate |
$1,109.76 |
| Rate for Payer: Aetna Commercial |
$890.12
|
| Rate for Payer: Anthem Medicaid |
$397.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cigna Commercial |
$959.48
|
| Rate for Payer: First Health Commercial |
$1,098.20
|
| Rate for Payer: Humana Commercial |
$982.60
|
| Rate for Payer: Humana KY Medicaid |
$397.55
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$401.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$405.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,017.28
|
| Rate for Payer: Ohio Health Group HMO |
$867.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$797.64
|
| Rate for Payer: PHCS Commercial |
$1,109.76
|
| Rate for Payer: United Healthcare All Payer |
$1,017.28
|
|
|
TREATMENT OF HEEL FRACTURE
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
76101011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$1,109.76 |
| Rate for Payer: Aetna Commercial |
$890.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$901.68
|
| Rate for Payer: Cash Price |
$578.00
|
| Rate for Payer: Cigna Commercial |
$959.48
|
| Rate for Payer: First Health Commercial |
$1,098.20
|
| Rate for Payer: Humana Commercial |
$982.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$947.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$853.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$346.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,017.28
|
| Rate for Payer: Ohio Health Group HMO |
$867.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$797.64
|
| Rate for Payer: PHCS Commercial |
$1,109.76
|
| Rate for Payer: United Healthcare All Payer |
$1,017.28
|
|
|
TREATMENT OF HEEL FRACTURE(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
761P1011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.63 |
| Max. Negotiated Rate |
$378.43 |
| Rate for Payer: Aetna Commercial |
$309.36
|
| Rate for Payer: Ambetter Exchange |
$220.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$141.59
|
| Rate for Payer: Anthem Medicaid |
$137.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.64
|
| 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 |
$137.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$270.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.38
|
| Rate for Payer: Molina Healthcare Passport |
$137.63
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$286.69
|
| Rate for Payer: UHCCP Medicaid |
$148.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.53
|
|
|
TREATMENT OF HEEL FRACTURE(T
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
761T1011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.80 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
TREATMENT OF HEEL FRACTURE(T
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
HCPCS 28400
|
| Hospital Charge Code |
761T1011
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.33 |
| Max. Negotiated Rate |
$514.56 |
| Rate for Payer: Aetna Commercial |
$412.72
|
| Rate for Payer: Anthem Medicaid |
$184.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$221.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$418.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$310.30
|
| Rate for Payer: CareSource Just4Me Medicare |
$299.21
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cigna Commercial |
$444.88
|
| Rate for Payer: First Health Commercial |
$509.20
|
| Rate for Payer: Humana Commercial |
$455.60
|
| Rate for Payer: Humana KY Medicaid |
$184.33
|
| Rate for Payer: Humana Medicare Advantage |
$221.64
|
| Rate for Payer: Kentucky WC Medicaid |
$186.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$439.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$395.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$265.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$188.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$471.68
|
| Rate for Payer: Ohio Health Group HMO |
$402.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.84
|
| Rate for Payer: PHCS Commercial |
$514.56
|
| Rate for Payer: United Healthcare All Payer |
$471.68
|
|
|
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 59812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER
|
Facility
|
OP
|
$4,112.95
|
|
|
Service Code
|
CPT 59820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,937.82 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
76102784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$533.76 |
| Rate for Payer: Aetna Commercial |
$428.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.68
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$461.48
|
| Rate for Payer: First Health Commercial |
$528.20
|
| Rate for Payer: Humana Commercial |
$472.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.28
|
| Rate for Payer: Ohio Health Group HMO |
$417.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.64
|
| Rate for Payer: PHCS Commercial |
$533.76
|
| Rate for Payer: United Healthcare All Payer |
$489.28
|
|
|
TREATMENT OF PENIS LESION
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
76102784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$333.60 |
| Rate for Payer: Aetna Commercial |
$134.40
|
| Rate for Payer: Ambetter Exchange |
$82.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.35
|
| Rate for Payer: Anthem Medicaid |
$38.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.31
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$163.82
|
| Rate for Payer: Healthspan PPO |
$167.97
|
| Rate for Payer: Humana Medicaid |
$38.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.73
|
| Rate for Payer: Molina Healthcare Passport |
$38.95
|
| Rate for Payer: Multiplan PHCS |
$333.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.59
|
| Rate for Payer: UHCCP Medicaid |
$58.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.76
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
76102784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$191.21 |
| Max. Negotiated Rate |
$533.76 |
| Rate for Payer: Aetna Commercial |
$428.12
|
| Rate for Payer: Anthem Medicaid |
$191.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$433.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cash Price |
$278.00
|
| Rate for Payer: Cigna Commercial |
$461.48
|
| Rate for Payer: First Health Commercial |
$528.20
|
| Rate for Payer: Humana Commercial |
$472.60
|
| Rate for Payer: Humana KY Medicaid |
$191.21
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$193.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$410.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$489.28
|
| Rate for Payer: Ohio Health Group HMO |
$417.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$444.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$383.64
|
| Rate for Payer: PHCS Commercial |
$533.76
|
| Rate for Payer: United Healthcare All Payer |
$489.28
|
|
|
TREATMENT OF PENIS LESION (P
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
761P2784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$167.97 |
| Rate for Payer: Aetna Commercial |
$134.40
|
| Rate for Payer: Ambetter Exchange |
$82.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.35
|
| Rate for Payer: Anthem Medicaid |
$38.95
|
| Rate for Payer: Buckeye Individual/Medicaid |
$82.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$82.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$99.31
|
| 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 |
$38.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$82.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$39.73
|
| Rate for Payer: Molina Healthcare Passport |
$38.95
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.59
|
| Rate for Payer: UHCCP Medicaid |
$58.12
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$82.76
|
|
|
TREATMENT OF PENIS LESION (T
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
761T2784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$144.78 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem Medicaid |
$144.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$224.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$314.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$303.37
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Humana KY Medicaid |
$144.78
|
| Rate for Payer: Humana Medicare Advantage |
$224.72
|
| Rate for Payer: Kentucky WC Medicaid |
$146.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$269.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$147.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.49
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
TREATMENT OF PENIS LESION (T
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
HCPCS 54200
|
| Hospital Charge Code |
761T2784
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.30 |
| Max. Negotiated Rate |
$404.16 |
| Rate for Payer: Aetna Commercial |
$324.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$328.38
|
| Rate for Payer: Cash Price |
$210.50
|
| Rate for Payer: Cigna Commercial |
$349.43
|
| Rate for Payer: First Health Commercial |
$399.95
|
| Rate for Payer: Humana Commercial |
$357.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$345.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$310.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$370.48
|
| Rate for Payer: Ohio Health Group HMO |
$315.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$336.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$366.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$290.49
|
| Rate for Payer: PHCS Commercial |
$404.16
|
| Rate for Payer: United Healthcare All Payer |
$370.48
|
|
|
TREATMENT OF SWALLOWING
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
44000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem Medicaid |
$60.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Humana KY Medicaid |
$60.53
|
| Rate for Payer: Kentucky WC Medicaid |
$61.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
|
TREATMENT OF SWALLOWING
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
HCPCS 92526
|
| Hospital Charge Code |
44000007
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.96 |
| Rate for Payer: Aetna Commercial |
$135.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.28
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna Commercial |
$146.08
|
| Rate for Payer: First Health Commercial |
$167.20
|
| Rate for Payer: Humana Commercial |
$149.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$144.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.88
|
| Rate for Payer: Ohio Health Group HMO |
$132.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$153.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.44
|
| Rate for Payer: PHCS Commercial |
$168.96
|
| Rate for Payer: United Healthcare All Payer |
$154.88
|
|
