|
CORONARY BYPASS SINGL VEIN GRA
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33517
|
| Hospital Charge Code |
76101301
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CORONARY ENDARTERECTOMY
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
76101313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CORONARY ENDARTERECTOMY
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
76101313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.00 |
| 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 |
$800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$870.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$690.00
|
| 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 |
$215.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$410.06
|
| Rate for Payer: Ambetter Exchange |
$215.20
|
| Rate for Payer: Anthem Medicaid |
$232.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$215.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$258.24
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$215.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.20
|
| 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 |
$279.76
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$234.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$215.20
|
|
|
CORONARY ENDARTERECTOMY(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 33572
|
| Hospital Charge Code |
761P1313
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$410.06
|
| Rate for Payer: Ambetter Exchange |
$215.20
|
| Rate for Payer: Anthem Medicaid |
$232.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$215.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$215.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$258.24
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$215.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$215.20
|
| 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 |
$279.76
|
| Rate for Payer: UHCCP Medicaid |
$350.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$234.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$215.20
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
IP
|
$6,713.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
76102468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,014.01 |
| 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 |
$5,035.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,370.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,632.23
|
| Rate for Payer: PHCS Commercial |
$6,444.84
|
| Rate for Payer: United Healthcare All Payer |
$5,907.77
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
OP
|
$6,713.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
76102468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,014.01 |
| 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 |
$5,035.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,370.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,840.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,632.23
|
| 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 |
$4,028.03 |
| Rate for Payer: Aetna Commercial |
$308.75
|
| Rate for Payer: Ambetter Exchange |
$164.08
|
| Rate for Payer: Anthem Medicaid |
$134.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.90
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$164.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.08
|
| 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 |
$213.30
|
| Rate for Payer: UHCCP Medicaid |
$2,349.68
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.08
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
IP
|
$13,777.00
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
48100058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,133.10 |
| Max. Negotiated Rate |
$13,225.92 |
| Rate for Payer: Aetna Commercial |
$10,608.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,746.06
|
| Rate for Payer: Cash Price |
$6,888.50
|
| Rate for Payer: Cigna Commercial |
$11,434.91
|
| Rate for Payer: First Health Commercial |
$13,088.15
|
| Rate for Payer: Humana Commercial |
$11,710.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,297.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,167.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,133.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,506.13
|
| Rate for Payer: PHCS Commercial |
$13,225.92
|
| Rate for Payer: United Healthcare All Payer |
$12,123.76
|
|
|
CORONARY THROMBECTOMY
|
Facility
|
OP
|
$13,777.00
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
48100058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,133.10 |
| Max. Negotiated Rate |
$13,225.92 |
| Rate for Payer: Aetna Commercial |
$10,608.29
|
| Rate for Payer: Anthem Medicaid |
$4,737.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,746.06
|
| Rate for Payer: Cash Price |
$6,888.50
|
| Rate for Payer: Cigna Commercial |
$11,434.91
|
| Rate for Payer: First Health Commercial |
$13,088.15
|
| Rate for Payer: Humana Commercial |
$11,710.45
|
| Rate for Payer: Humana KY Medicaid |
$4,737.91
|
| Rate for Payer: Kentucky WC Medicaid |
$4,786.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,297.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,167.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,133.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,832.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,123.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,332.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,021.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,985.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,506.13
|
| Rate for Payer: PHCS Commercial |
$13,225.92
|
| Rate for Payer: United Healthcare All Payer |
$12,123.76
|
|
|
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: Ambetter Exchange |
$164.08
|
| Rate for Payer: Anthem Medicaid |
$134.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$164.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$164.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.90
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$164.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.08
|
| 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 |
$213.30
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$164.08
|
|
|
CORONARY THROMBECTOMY(T
|
Facility
|
IP
|
$6,438.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
761T2468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,931.51 |
| 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 |
$5,150.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,601.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,442.48
|
| Rate for Payer: PHCS Commercial |
$6,180.84
|
| Rate for Payer: United Healthcare All Payer |
$5,665.77
|
|
|
CORONARY THROMBECTOMY(T
|
Facility
|
OP
|
$6,438.38
|
|
|
Service Code
|
HCPCS 92973
|
| Hospital Charge Code |
761T2468
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,931.51 |
| 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 |
$5,150.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,601.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,442.48
|
| 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
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
COROX OTW-S 75-BP
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
27000068
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
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: Ambetter Exchange |
$566.32
|
| 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 Individual/Medicaid |
$566.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$566.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$679.58
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$566.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.32
|
| 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 |
$736.22
|
| Rate for Payer: UHCCP Medicaid |
$347.22
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$551.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$566.32
|
|
|
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 |
$906.86 |
| Rate for Payer: Aetna Commercial |
$789.24
|
| Rate for Payer: Ambetter Exchange |
$481.14
|
| 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 Individual/Medicaid |
$481.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$481.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$577.37
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$481.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$481.14
|
| 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 |
$625.48
|
| Rate for Payer: UHCCP Medicaid |
$299.38
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$483.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$481.14
|
|
|
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: Ambetter Exchange |
$462.19
|
| 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 Individual/Medicaid |
$462.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$462.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$554.63
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$462.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.19
|
| 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 |
$600.85
|
| Rate for Payer: UHCCP Medicaid |
$263.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$462.19
|
|
|
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 |
$1,053.80 |
| Rate for Payer: Aetna Commercial |
$929.53
|
| Rate for Payer: Ambetter Exchange |
$568.20
|
| 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 Individual/Medicaid |
$568.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$568.20
|
| Rate for Payer: CareSource Just4Me Medicare |
$681.84
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$568.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.20
|
| 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 |
$738.66
|
| Rate for Payer: UHCCP Medicaid |
$329.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$527.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$568.20
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 28299
|
| Hospital Charge Code |
76102857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$338.74 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,240.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,910.89
|
| 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 |
$6,600.66
|
| 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 |
$7,920.79
|
| 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 |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
CORRECTION HALLUX VALGUS
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 28299
|
| Hospital Charge Code |
76102857
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$295.50 |
| 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 |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
|
OP
|
$16,644.15
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,888.68 |
| Max. Negotiated Rate |
$16,644.15 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,888.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,644.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$16,049.72
|
| Rate for Payer: Humana Medicare Advantage |
$11,888.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,266.42
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$5,768.63
|
|
|
Service Code
|
HCPCS 19355
|
| Hospital Charge Code |
76100314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.09 |
| Max. Negotiated Rate |
$3,461.18 |
| Rate for Payer: Aetna Commercial |
$807.74
|
| Rate for Payer: Ambetter Exchange |
$584.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$584.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$584.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$700.91
|
| Rate for Payer: Cash Price |
$2,884.32
|
| Rate for Payer: Cash Price |
$2,884.32
|
| Rate for Payer: Cigna Commercial |
$1,028.84
|
| Rate for Payer: Healthspan PPO |
$792.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$725.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$584.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.09
|
| Rate for Payer: Multiplan PHCS |
$3,461.18
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$759.32
|
| Rate for Payer: UHCCP Medicaid |
$2,019.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$584.09
|
|
