|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$94,933.27
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$64,419.01 |
| Max. Negotiated Rate |
$94,933.27 |
| Rate for Payer: Anthem Medicaid |
$64,419.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$67,809.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$94,933.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$91,542.80
|
| Rate for Payer: Humana KY Medicaid |
$64,419.01
|
| Rate for Payer: Humana Medicare Advantage |
$67,809.48
|
| Rate for Payer: Kentucky WC Medicaid |
$65,063.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81,371.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$65,707.39
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$69,587.92
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$47,220.38 |
| Max. Negotiated Rate |
$69,587.92 |
| Rate for Payer: Anthem Medicaid |
$47,220.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$49,705.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$69,587.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$67,102.64
|
| Rate for Payer: Humana KY Medicaid |
$47,220.38
|
| Rate for Payer: Humana Medicare Advantage |
$49,705.66
|
| Rate for Payer: Kentucky WC Medicaid |
$47,692.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59,646.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$48,164.78
|
|
|
CORONARY ENDARTERECTOMY
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
76101313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CORONARY ENDARTERECTOMY
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
76101313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.52 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$410.06
|
| Rate for Payer: Anthem Medicaid |
$232.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$381.21
|
| Rate for Payer: Healthspan PPO |
$403.17
|
| Rate for Payer: Humana Medicaid |
$232.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$331.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.17
|
| Rate for Payer: Molina Healthcare Passport |
$232.52
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$234.85
|
|
|
CORONARY ENDARTERECTOMY
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
76101313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CORONARY ENDARTERECTOMY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
761P1313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.52 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$410.06
|
| Rate for Payer: Anthem Medicaid |
$232.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$381.21
|
| Rate for Payer: Healthspan PPO |
$403.17
|
| Rate for Payer: Humana Medicaid |
$232.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$331.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$237.17
|
| Rate for Payer: Molina Healthcare Passport |
$232.52
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$234.85
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$48,430.56
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$32,863.60 |
| Max. Negotiated Rate |
$48,430.56 |
| Rate for Payer: Anthem Medicaid |
$32,863.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34,593.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48,430.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$46,700.90
|
| Rate for Payer: Humana KY Medicaid |
$32,863.60
|
| Rate for Payer: Humana Medicare Advantage |
$34,593.26
|
| Rate for Payer: Kentucky WC Medicaid |
$33,192.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41,511.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,520.87
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$34,727.29
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$23,564.95 |
| Max. Negotiated Rate |
$34,727.29 |
| Rate for Payer: Anthem Medicaid |
$23,564.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24,805.21
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34,727.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,487.03
|
| Rate for Payer: Humana KY Medicaid |
$23,564.95
|
| Rate for Payer: Humana Medicare Advantage |
$24,805.21
|
| Rate for Payer: Kentucky WC Medicaid |
$23,800.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,766.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,036.25
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$30,933.56
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$20,990.63 |
| Max. Negotiated Rate |
$30,933.56 |
| Rate for Payer: Anthem Medicaid |
$20,990.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,095.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$30,933.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$29,828.79
|
| Rate for Payer: Humana KY Medicaid |
$20,990.63
|
| Rate for Payer: Humana Medicare Advantage |
$22,095.40
|
| Rate for Payer: Kentucky WC Medicaid |
$21,200.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,514.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,410.44
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
OP
|
$6,713.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
76102468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.74 |
| Max. Negotiated Rate |
$6,444.84 |
| Rate for Payer: Aetna Commercial |
$5,169.30
|
| Rate for Payer: Anthem Medicaid |
$2,308.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,236.44
|
| Rate for Payer: Cash Price |
$3,356.69
|
| Rate for Payer: Cigna Commercial |
$5,572.11
|
| Rate for Payer: First Health Commercial |
$6,377.71
|
| Rate for Payer: Humana Commercial |
$5,706.37
|
| Rate for Payer: Humana KY Medicaid |
$2,308.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,332.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,504.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,954.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,014.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,355.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,907.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,035.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,081.15
|
| Rate for Payer: PHCS Commercial |
$6,444.84
|
| Rate for Payer: United Healthcare All Payer |
$5,907.77
|
|
|
CORONARY THROMBECTOMY
|
Professional
|
Both
|
$6,713.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
76102468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.01 |
| Max. Negotiated Rate |
$6,713.38 |
| Rate for Payer: Aetna Commercial |
$308.75
|
| Rate for Payer: Anthem Medicaid |
$134.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,713.38
|
| Rate for Payer: Cash Price |
$3,356.69
|
| Rate for Payer: Cash Price |
$3,356.69
|
| Rate for Payer: Cigna Commercial |
$277.05
|
| Rate for Payer: Healthspan PPO |
$290.21
|
| Rate for Payer: Humana Medicaid |
$134.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.69
|
| Rate for Payer: Molina Healthcare Passport |
$134.01
|
| Rate for Payer: Multiplan PHCS |
$4,028.03
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,699.37
|
| Rate for Payer: UHCCP Medicaid |
$2,349.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.35
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
IP
|
$6,713.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
76102468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$872.74 |
| Max. Negotiated Rate |
$6,444.84 |
| Rate for Payer: Aetna Commercial |
$5,169.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,236.44
|
| Rate for Payer: Cash Price |
$3,356.69
|
| Rate for Payer: Cigna Commercial |
$5,572.11
|
| Rate for Payer: First Health Commercial |
$6,377.71
|
| Rate for Payer: Humana Commercial |
$5,706.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,504.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,954.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,014.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,907.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,035.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,342.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,081.15
|
| Rate for Payer: PHCS Commercial |
$6,444.84
|
| Rate for Payer: United Healthcare All Payer |
$5,907.77
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
OP
|
$12,936.00
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
48100058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.68 |
| Max. Negotiated Rate |
$12,418.56 |
| Rate for Payer: Aetna Commercial |
$9,960.72
|
| Rate for Payer: Anthem Medicaid |
$4,448.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,090.08
|
| Rate for Payer: Cash Price |
$6,468.00
|
| Rate for Payer: Cigna Commercial |
$10,736.88
|
| Rate for Payer: First Health Commercial |
$12,289.20
|
| Rate for Payer: Humana Commercial |
$10,995.60
|
| Rate for Payer: Humana KY Medicaid |
$4,448.69
|
| Rate for Payer: Kentucky WC Medicaid |
$4,493.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,607.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,546.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,880.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,537.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,383.68
|
| Rate for Payer: Ohio Health Group HMO |
$9,702.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,010.16
|
| Rate for Payer: PHCS Commercial |
$12,418.56
|
| Rate for Payer: United Healthcare All Payer |
$11,383.68
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
IP
|
$12,936.00
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
48100058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,681.68 |
| Max. Negotiated Rate |
$12,418.56 |
| Rate for Payer: Aetna Commercial |
$9,960.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,090.08
|
| Rate for Payer: Cash Price |
$6,468.00
|
| Rate for Payer: Cigna Commercial |
$10,736.88
|
| Rate for Payer: First Health Commercial |
$12,289.20
|
| Rate for Payer: Humana Commercial |
$10,995.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,607.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,546.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,880.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,383.68
|
| Rate for Payer: Ohio Health Group HMO |
$9,702.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,587.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,010.16
|
| Rate for Payer: PHCS Commercial |
$12,418.56
|
| Rate for Payer: United Healthcare All Payer |
$11,383.68
|
|
|
CORONARY THROMBECTOMY(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
761P2468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$308.75
|
| Rate for Payer: Anthem Medicaid |
$134.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$277.05
|
| Rate for Payer: Healthspan PPO |
$290.21
|
| Rate for Payer: Humana Medicaid |
$134.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.69
|
| Rate for Payer: Molina Healthcare Passport |
$134.01
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.35
|
|
|
CORONARY THROMBECTOMY(T
|
Facility
|
OP
|
$6,438.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
761T2468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.99 |
| Max. Negotiated Rate |
$6,180.84 |
| Rate for Payer: Aetna Commercial |
$4,957.55
|
| Rate for Payer: Anthem Medicaid |
$2,214.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,021.94
|
| Rate for Payer: Cash Price |
$3,219.19
|
| Rate for Payer: Cigna Commercial |
$5,343.86
|
| Rate for Payer: First Health Commercial |
$6,116.46
|
| Rate for Payer: Humana Commercial |
$5,472.62
|
| Rate for Payer: Humana KY Medicaid |
$2,214.16
|
| Rate for Payer: Kentucky WC Medicaid |
$2,236.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,279.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,751.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,931.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,258.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,665.77
|
| Rate for Payer: Ohio Health Group HMO |
$4,828.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,287.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,995.90
|
| Rate for Payer: PHCS Commercial |
$6,180.84
|
| Rate for Payer: United Healthcare All Payer |
$5,665.77
|
|
|
CORONARY THROMBECTOMY(T
|
Facility
|
IP
|
$6,438.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
761T2468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$836.99 |
| Max. Negotiated Rate |
$6,180.84 |
| Rate for Payer: Aetna Commercial |
$4,957.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,021.94
|
| Rate for Payer: Cash Price |
$3,219.19
|
| Rate for Payer: Cigna Commercial |
$5,343.86
|
| Rate for Payer: First Health Commercial |
$6,116.46
|
| Rate for Payer: Humana Commercial |
$5,472.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,279.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,751.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,931.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,665.77
|
| Rate for Payer: Ohio Health Group HMO |
$4,828.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,287.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$836.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,995.90
|
| Rate for Payer: PHCS Commercial |
$6,180.84
|
| Rate for Payer: United Healthcare All Payer |
$5,665.77
|
|
|
COROX OTW-S 75-BP
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
COROX OTW-S 75-BP
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$1,950.00 |
| Max. Negotiated Rate |
$14,400.00 |
| Rate for Payer: Aetna Commercial |
$11,550.00
|
| Rate for Payer: Anthem Medicaid |
$5,158.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,700.00
|
| Rate for Payer: Cash Price |
$7,500.00
|
| Rate for Payer: Cigna Commercial |
$12,450.00
|
| Rate for Payer: First Health Commercial |
$14,250.00
|
| Rate for Payer: Humana Commercial |
$12,750.00
|
| Rate for Payer: Humana KY Medicaid |
$5,158.50
|
| Rate for Payer: Kentucky WC Medicaid |
$5,211.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,300.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,070.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,262.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,650.00
|
| Rate for Payer: PHCS Commercial |
$14,400.00
|
| Rate for Payer: United Healthcare All Payer |
$13,200.00
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 28297
|
| Hospital Charge Code |
51000289
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.48 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$929.53
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$313.48
|
| Rate for Payer: Anthem Medicaid |
$522.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,235.00
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,019.68
|
| Rate for Payer: Healthspan PPO |
$1,053.80
|
| Rate for Payer: Humana Medicaid |
$522.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$741.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$532.89
|
| Rate for Payer: Molina Healthcare Passport |
$522.44
|
| Rate for Payer: Multiplan PHCS |
$741.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$864.50
|
| Rate for Payer: UHCCP Medicaid |
$329.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$527.66
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 28299
|
| Hospital Charge Code |
76102857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 28299
|
| Hospital Charge Code |
76102857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.69 |
| Max. Negotiated Rate |
$1,169.69 |
| Rate for Payer: Aetna Commercial |
$1,068.16
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$330.69
|
| Rate for Payer: Anthem Medicaid |
$546.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$985.00
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$1,145.84
|
| Rate for Payer: Healthspan PPO |
$1,169.69
|
| Rate for Payer: Humana Medicaid |
$546.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$847.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$557.39
|
| Rate for Payer: Molina Healthcare Passport |
$546.46
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$347.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.92
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 28292
|
| Hospital Charge Code |
76102748
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.85 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$887.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$250.85
|
| Rate for Payer: Anthem Medicaid |
$390.18
|
| 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 |
$938.11
|
| Rate for Payer: Healthspan PPO |
$973.75
|
| Rate for Payer: Humana Medicaid |
$390.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$739.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.98
|
| Rate for Payer: Molina Healthcare Passport |
$390.18
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$263.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.08
|
|
|
CORRECTION HALLUX VALGUS
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 28298
|
| Hospital Charge Code |
76102719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.12 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$789.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$285.12
|
| Rate for Payer: Anthem Medicaid |
$478.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$853.88
|
| Rate for Payer: Healthspan PPO |
$906.86
|
| Rate for Payer: Humana Medicaid |
$478.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$630.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.88
|
| Rate for Payer: Molina Healthcare Passport |
$478.31
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$299.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.09
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 28299
|
| Hospital Charge Code |
76102857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$197.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.35
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
