|
CLOSED TX TARSOMETATARSAL DIS
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
76101031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$1,210.56 |
| Rate for Payer: Aetna Commercial |
$970.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$983.58
|
| Rate for Payer: Cash Price |
$630.50
|
| Rate for Payer: Cigna Commercial |
$1,046.63
|
| Rate for Payer: First Health Commercial |
$1,197.95
|
| Rate for Payer: Humana Commercial |
$1,071.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,034.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$930.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,109.68
|
| Rate for Payer: Ohio Health Group HMO |
$945.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.91
|
| Rate for Payer: PHCS Commercial |
$1,210.56
|
| Rate for Payer: United Healthcare All Payer |
$1,109.68
|
|
|
CLOSED TX TARSOMETATARSAL DI(T
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
761T1031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem Medicaid |
$235.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Humana KY Medicaid |
$235.92
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$238.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.66
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
CLOSED TX TARSOMETATARSAL DI(T
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
HCPCS 28600
|
| Hospital Charge Code |
761T1031
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.66
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
CLOSED TX VERT FX W/MANJ
|
Facility
|
IP
|
$5,321.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
76100420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.73 |
| Max. Negotiated Rate |
$5,108.16 |
| Rate for Payer: Aetna Commercial |
$4,097.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,150.38
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cigna Commercial |
$4,416.43
|
| Rate for Payer: First Health Commercial |
$5,054.95
|
| Rate for Payer: Humana Commercial |
$4,522.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,363.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,926.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,596.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,682.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,990.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,649.51
|
| Rate for Payer: PHCS Commercial |
$5,108.16
|
| Rate for Payer: United Healthcare All Payer |
$4,682.48
|
|
|
CLOSED TX VERT FX W/MANJ
|
Professional
|
Both
|
$5,321.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
76100420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.90 |
| Max. Negotiated Rate |
$5,321.00 |
| Rate for Payer: Aetna Commercial |
$1,104.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$414.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,321.00
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cigna Commercial |
$1,172.62
|
| Rate for Payer: Healthspan PPO |
$1,112.70
|
| Rate for Payer: Humana Medicaid |
$414.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.28
|
| Rate for Payer: Molina Healthcare Passport |
$414.00
|
| Rate for Payer: Multiplan PHCS |
$3,192.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,724.70
|
| Rate for Payer: UHCCP Medicaid |
$415.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.14
|
|
|
CLOSED TX VERT FX W/MANJ
|
Facility
|
OP
|
$5,321.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
76100420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$691.73 |
| Max. Negotiated Rate |
$5,108.16 |
| Rate for Payer: Aetna Commercial |
$4,097.17
|
| Rate for Payer: Anthem Medicaid |
$1,829.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,150.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cash Price |
$2,660.50
|
| Rate for Payer: Cigna Commercial |
$4,416.43
|
| Rate for Payer: First Health Commercial |
$5,054.95
|
| Rate for Payer: Humana Commercial |
$4,522.85
|
| Rate for Payer: Humana KY Medicaid |
$1,829.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,848.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,363.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,926.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,866.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,682.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,990.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,649.51
|
| Rate for Payer: PHCS Commercial |
$5,108.16
|
| Rate for Payer: United Healthcare All Payer |
$4,682.48
|
|
|
CLOSED TX VERT FX W/MANJ(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
761P0420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$395.90 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,104.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$395.90
|
| Rate for Payer: Anthem Medicaid |
$414.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,172.62
|
| Rate for Payer: Healthspan PPO |
$1,112.70
|
| Rate for Payer: Humana Medicaid |
$414.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$960.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$422.28
|
| Rate for Payer: Molina Healthcare Passport |
$414.00
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$415.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$418.14
|
|
|
CLOSED TX VERT FX W/MANJ(T
|
Facility
|
OP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
761T0420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem Medicaid |
$1,348.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Humana KY Medicaid |
$1,348.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLOSED TX VERT FX W/MANJ(T
|
Facility
|
IP
|
$3,921.00
|
|
|
Service Code
|
HCPCS 22315
|
| Hospital Charge Code |
761T0420
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$3,764.16 |
| Rate for Payer: Aetna Commercial |
$3,019.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,058.38
|
| Rate for Payer: Cash Price |
$1,960.50
|
| Rate for Payer: Cigna Commercial |
$3,254.43
|
| Rate for Payer: First Health Commercial |
$3,724.95
|
| Rate for Payer: Humana Commercial |
$3,332.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,215.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,893.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,450.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,940.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.51
|
| Rate for Payer: PHCS Commercial |
$3,764.16
|
| Rate for Payer: United Healthcare All Payer |
$3,450.48
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
76100419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,391.04 |
| Rate for Payer: Aetna Commercial |
$1,115.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,130.22
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna Commercial |
$1,202.67
|
| Rate for Payer: First Health Commercial |
$1,376.55
|
| Rate for Payer: Humana Commercial |
$1,231.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,188.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,069.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$434.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,275.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,086.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.19
|
| Rate for Payer: PHCS Commercial |
$1,391.04
|
| Rate for Payer: United Healthcare All Payer |
$1,275.12
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
76100419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$383.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$152.96
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,449.00
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna Commercial |
$431.26
|
| Rate for Payer: Healthspan PPO |
$370.14
|
| Rate for Payer: Humana Medicaid |
$138.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$344.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.72
|
| Rate for Payer: Molina Healthcare Passport |
$138.94
|
| Rate for Payer: Multiplan PHCS |
$869.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,014.30
|
| Rate for Payer: UHCCP Medicaid |
$160.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.33
|
|
|
CLOSED TX VERT FX W/O MANJ
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
76100419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,391.04 |
| Rate for Payer: Aetna Commercial |
$1,115.73
|
| Rate for Payer: Anthem Medicaid |
$498.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,130.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cash Price |
$724.50
|
| Rate for Payer: Cigna Commercial |
$1,202.67
|
| Rate for Payer: First Health Commercial |
$1,376.55
|
| Rate for Payer: Humana Commercial |
$1,231.65
|
| Rate for Payer: Humana KY Medicaid |
$498.31
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$503.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,188.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,069.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,275.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,086.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.19
|
| Rate for Payer: PHCS Commercial |
$1,391.04
|
| Rate for Payer: United Healthcare All Payer |
$1,275.12
|
|
|
CLOSED TX VERT FX W/O MANJ(P
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
761P0419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna Commercial |
$383.49
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$152.96
|
| Rate for Payer: Anthem Medicaid |
$138.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$725.00
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cash Price |
$362.50
|
| Rate for Payer: Cigna Commercial |
$431.26
|
| Rate for Payer: Healthspan PPO |
$370.14
|
| Rate for Payer: Humana Medicaid |
$138.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$344.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$141.72
|
| Rate for Payer: Molina Healthcare Passport |
$138.94
|
| Rate for Payer: Multiplan PHCS |
$435.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$507.50
|
| Rate for Payer: UHCCP Medicaid |
$160.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$140.33
|
|
|
CLOSED TX VERT FX W/O MANJ(T
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
761T0419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$695.04 |
| Rate for Payer: Aetna Commercial |
$557.48
|
| Rate for Payer: Anthem Medicaid |
$248.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$600.92
|
| Rate for Payer: First Health Commercial |
$687.80
|
| Rate for Payer: Humana Commercial |
$615.40
|
| Rate for Payer: Humana KY Medicaid |
$248.98
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$251.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$593.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$534.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$253.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$637.12
|
| Rate for Payer: Ohio Health Group HMO |
$543.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.44
|
| Rate for Payer: PHCS Commercial |
$695.04
|
| Rate for Payer: United Healthcare All Payer |
$637.12
|
|
|
CLOSED TX VERT FX W/O MANJ(T
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
HCPCS 22310
|
| Hospital Charge Code |
761T0419
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.12 |
| Max. Negotiated Rate |
$695.04 |
| Rate for Payer: Aetna Commercial |
$557.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$564.72
|
| Rate for Payer: Cash Price |
$362.00
|
| Rate for Payer: Cigna Commercial |
$600.92
|
| Rate for Payer: First Health Commercial |
$687.80
|
| Rate for Payer: Humana Commercial |
$615.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$593.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$534.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$217.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$637.12
|
| Rate for Payer: Ohio Health Group HMO |
$543.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$224.44
|
| Rate for Payer: PHCS Commercial |
$695.04
|
| Rate for Payer: United Healthcare All Payer |
$637.12
|
|
|
CLOSE MASTOID FISTULA
|
Professional
|
Both
|
$3,678.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
76102436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.10 |
| Max. Negotiated Rate |
$3,678.00 |
| Rate for Payer: Aetna Commercial |
$987.61
|
| Rate for Payer: Anthem Medicaid |
$465.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,678.00
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cigna Commercial |
$992.16
|
| Rate for Payer: Healthspan PPO |
$876.05
|
| Rate for Payer: Humana Medicaid |
$465.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$881.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.40
|
| Rate for Payer: Molina Healthcare Passport |
$465.10
|
| Rate for Payer: Multiplan PHCS |
$2,206.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,574.60
|
| Rate for Payer: UHCCP Medicaid |
$1,287.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.75
|
|
|
CLOSE MASTOID FISTULA
|
Facility
|
IP
|
$3,678.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
76102436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.14 |
| Max. Negotiated Rate |
$3,530.88 |
| Rate for Payer: Aetna Commercial |
$2,832.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,868.84
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cigna Commercial |
$3,052.74
|
| Rate for Payer: First Health Commercial |
$3,494.10
|
| Rate for Payer: Humana Commercial |
$3,126.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,015.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,714.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,103.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,236.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,758.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.18
|
| Rate for Payer: PHCS Commercial |
$3,530.88
|
| Rate for Payer: United Healthcare All Payer |
$3,236.64
|
|
|
CLOSE MASTOID FISTULA
|
Facility
|
OP
|
$3,678.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
76102436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$478.14 |
| Max. Negotiated Rate |
$3,530.88 |
| Rate for Payer: Aetna Commercial |
$2,832.06
|
| Rate for Payer: Anthem Medicaid |
$1,264.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,868.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Cigna Commercial |
$3,052.74
|
| Rate for Payer: First Health Commercial |
$3,494.10
|
| Rate for Payer: Humana Commercial |
$3,126.30
|
| Rate for Payer: Humana KY Medicaid |
$1,264.86
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,015.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,714.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,290.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,236.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,758.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$735.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.18
|
| Rate for Payer: PHCS Commercial |
$3,530.88
|
| Rate for Payer: United Healthcare All Payer |
$3,236.64
|
|
|
CLOSE MASTOID FISTULA(P
|
Professional
|
Both
|
$1,745.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
761P2436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$465.10 |
| Max. Negotiated Rate |
$1,745.00 |
| Rate for Payer: Aetna Commercial |
$987.61
|
| Rate for Payer: Anthem Medicaid |
$465.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,745.00
|
| Rate for Payer: Cash Price |
$872.50
|
| Rate for Payer: Cash Price |
$872.50
|
| Rate for Payer: Cigna Commercial |
$992.16
|
| Rate for Payer: Healthspan PPO |
$876.05
|
| Rate for Payer: Humana Medicaid |
$465.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$881.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$474.40
|
| Rate for Payer: Molina Healthcare Passport |
$465.10
|
| Rate for Payer: Multiplan PHCS |
$1,047.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,221.50
|
| Rate for Payer: UHCCP Medicaid |
$610.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$469.75
|
|
|
CLOSE MASTOID FISTULA(T
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
761T2436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
CLOSE MASTOID FISTULA(T
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
HCPCS 69700
|
| Hospital Charge Code |
761T2436
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$1,855.68 |
| Rate for Payer: Aetna Commercial |
$1,488.41
|
| Rate for Payer: Anthem Medicaid |
$664.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cash Price |
$966.50
|
| Rate for Payer: Cigna Commercial |
$1,604.39
|
| Rate for Payer: First Health Commercial |
$1,836.35
|
| Rate for Payer: Humana Commercial |
$1,643.05
|
| Rate for Payer: Humana KY Medicaid |
$664.76
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$671.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,585.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,701.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.23
|
| Rate for Payer: PHCS Commercial |
$1,855.68
|
| Rate for Payer: United Healthcare All Payer |
$1,701.04
|
|
|
CLOS ENTER - W CLOSURE ANASTO
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
76101861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.65 |
| Max. Negotiated Rate |
$2,347.26 |
| Rate for Payer: Aetna Commercial |
$2,347.26
|
| Rate for Payer: Anthem Medicaid |
$1,002.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,199.00
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$2,192.44
|
| Rate for Payer: Healthspan PPO |
$1,979.49
|
| Rate for Payer: Humana Medicaid |
$1,002.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,022.58
|
| Rate for Payer: Molina Healthcare Passport |
$1,002.53
|
| Rate for Payer: Multiplan PHCS |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,539.30
|
| Rate for Payer: UHCCP Medicaid |
$769.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,012.56
|
|
|
CLOS ENTER - W CLOSURE ANASTO
|
Facility
|
IP
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
76101861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.87 |
| Max. Negotiated Rate |
$2,111.04 |
| Rate for Payer: Aetna Commercial |
$1,693.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.22
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$1,825.17
|
| Rate for Payer: First Health Commercial |
$2,089.05
|
| Rate for Payer: Humana Commercial |
$1,869.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,622.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.69
|
| Rate for Payer: PHCS Commercial |
$2,111.04
|
| Rate for Payer: United Healthcare All Payer |
$1,935.12
|
|
|
CLOS ENTER - W CLOSURE ANASTO
|
Facility
|
OP
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
76101861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$285.87 |
| Max. Negotiated Rate |
$2,111.04 |
| Rate for Payer: Aetna Commercial |
$1,693.23
|
| Rate for Payer: Anthem Medicaid |
$756.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.22
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$1,825.17
|
| Rate for Payer: First Health Commercial |
$2,089.05
|
| Rate for Payer: Humana Commercial |
$1,869.15
|
| Rate for Payer: Humana KY Medicaid |
$756.24
|
| Rate for Payer: Kentucky WC Medicaid |
$763.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,622.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.69
|
| Rate for Payer: PHCS Commercial |
$2,111.04
|
| Rate for Payer: United Healthcare All Payer |
$1,935.12
|
|
|
CLOS ENTER - W CLOSURE ANAST(P
|
Professional
|
Both
|
$2,199.00
|
|
|
Service Code
|
HCPCS 44626
|
| Hospital Charge Code |
761P1861
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$769.65 |
| Max. Negotiated Rate |
$2,347.26 |
| Rate for Payer: Aetna Commercial |
$2,347.26
|
| Rate for Payer: Anthem Medicaid |
$1,002.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,199.00
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cash Price |
$1,099.50
|
| Rate for Payer: Cigna Commercial |
$2,192.44
|
| Rate for Payer: Healthspan PPO |
$1,979.49
|
| Rate for Payer: Humana Medicaid |
$1,002.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,059.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,022.58
|
| Rate for Payer: Molina Healthcare Passport |
$1,002.53
|
| Rate for Payer: Multiplan PHCS |
$1,319.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,539.30
|
| Rate for Payer: UHCCP Medicaid |
$769.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,012.56
|
|
