|
CORRECTION INVERTED NIPPLES
|
Facility
|
OP
|
$5,768.63
|
|
|
Service Code
|
HCPCS 19355
|
| Hospital Charge Code |
76100314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,983.83 |
| Max. Negotiated Rate |
$5,537.88 |
| Rate for Payer: Aetna Commercial |
$4,441.85
|
| Rate for Payer: Anthem Medicaid |
$1,983.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,499.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,884.32
|
| Rate for Payer: Cash Price |
$2,884.32
|
| Rate for Payer: Cigna Commercial |
$4,787.96
|
| Rate for Payer: First Health Commercial |
$5,480.20
|
| Rate for Payer: Humana Commercial |
$4,903.34
|
| Rate for Payer: Humana KY Medicaid |
$1,983.83
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,004.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,730.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,257.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,023.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,076.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,326.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,614.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,018.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,980.35
|
| Rate for Payer: PHCS Commercial |
$5,537.88
|
| Rate for Payer: United Healthcare All Payer |
$5,076.39
|
|
|
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
|
|
|
CORRECTION INVERTED NIPPLES(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 19355
|
| Hospital Charge Code |
761P0314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$1,028.84 |
| 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 |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| 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 |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$759.32
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$584.09
|
|
|
CORRECTION INVERTED NIPPLES(T
|
Facility
|
OP
|
$4,568.63
|
|
|
Service Code
|
HCPCS 19355
|
| Hospital Charge Code |
761T0314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,571.15 |
| Max. Negotiated Rate |
$4,953.45 |
| Rate for Payer: Aetna Commercial |
$3,517.85
|
| Rate for Payer: Anthem Medicaid |
$1,571.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,538.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,563.53
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,953.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,776.54
|
| Rate for Payer: Cash Price |
$2,284.32
|
| Rate for Payer: Cash Price |
$2,284.32
|
| Rate for Payer: Cigna Commercial |
$3,791.96
|
| Rate for Payer: First Health Commercial |
$4,340.20
|
| Rate for Payer: Humana Commercial |
$3,883.34
|
| Rate for Payer: Humana KY Medicaid |
$1,571.15
|
| Rate for Payer: Humana Medicare Advantage |
$3,538.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,587.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,746.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,245.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,602.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,020.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,426.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,654.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,974.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,152.35
|
| Rate for Payer: PHCS Commercial |
$4,385.88
|
| Rate for Payer: United Healthcare All Payer |
$4,020.39
|
|
|
CORRECTION INVERTED NIPPLES(T
|
Facility
|
IP
|
$4,568.63
|
|
|
Service Code
|
HCPCS 19355
|
| Hospital Charge Code |
761T0314
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,370.59 |
| Max. Negotiated Rate |
$4,385.88 |
| Rate for Payer: Aetna Commercial |
$3,517.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,563.53
|
| Rate for Payer: Cash Price |
$2,284.32
|
| Rate for Payer: Cigna Commercial |
$3,791.96
|
| Rate for Payer: First Health Commercial |
$4,340.20
|
| Rate for Payer: Humana Commercial |
$3,883.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,746.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,020.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,426.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,654.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,974.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,152.35
|
| Rate for Payer: PHCS Commercial |
$4,385.88
|
| Rate for Payer: United Healthcare All Payer |
$4,020.39
|
|
|
CORRECT MALROTATION OF BOWEL
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 44055
|
| Hospital Charge Code |
76102660
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$594.11 |
| Max. Negotiated Rate |
$2,157.33 |
| Rate for Payer: Aetna Commercial |
$2,157.33
|
| Rate for Payer: Ambetter Exchange |
$1,423.22
|
| Rate for Payer: Anthem Medicaid |
$594.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,423.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,423.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,707.86
|
| Rate for Payer: Cash Price |
$1,217.50
|
| Rate for Payer: Cash Price |
$1,217.50
|
| Rate for Payer: Cigna Commercial |
$1,999.12
|
| Rate for Payer: Healthspan PPO |
$1,819.31
|
| Rate for Payer: Humana Medicaid |
$594.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,912.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,423.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$605.99
|
| Rate for Payer: Molina Healthcare Passport |
$594.11
|
| Rate for Payer: Multiplan PHCS |
$1,461.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,850.19
|
| Rate for Payer: UHCCP Medicaid |
$852.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$600.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,423.22
|
|
|
CORRECT SKN COLOR 6.1-20.0CM
|
Professional
|
Both
|
$2,572.20
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
76100109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.04 |
| Max. Negotiated Rate |
$1,543.32 |
| Rate for Payer: Aetna Commercial |
$200.57
|
| Rate for Payer: Ambetter Exchange |
$123.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$123.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.65
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cigna Commercial |
$320.43
|
| Rate for Payer: Healthspan PPO |
$232.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$123.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.04
|
| Rate for Payer: Multiplan PHCS |
$1,543.32
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.95
|
| Rate for Payer: UHCCP Medicaid |
$900.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.04
|
|
|
CORRECT SKN COLOR 6.1-20.0CM
|
Facility
|
OP
|
$2,572.20
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
76100109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$2,469.31 |
| Rate for Payer: Aetna Commercial |
$1,980.59
|
| Rate for Payer: Anthem Medicaid |
$884.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,006.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cigna Commercial |
$2,134.93
|
| Rate for Payer: First Health Commercial |
$2,443.59
|
| Rate for Payer: Humana Commercial |
$2,186.37
|
| Rate for Payer: Humana KY Medicaid |
$884.58
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$893.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,109.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,898.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$902.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,263.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,929.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,057.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,237.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,774.82
|
| Rate for Payer: PHCS Commercial |
$2,469.31
|
| Rate for Payer: United Healthcare All Payer |
$2,263.54
|
|
|
CORRECT SKN COLOR 6.1-20.0CM
|
Facility
|
IP
|
$2,572.20
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
76100109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$771.66 |
| Max. Negotiated Rate |
$2,469.31 |
| Rate for Payer: Aetna Commercial |
$1,980.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,006.32
|
| Rate for Payer: Cash Price |
$1,286.10
|
| Rate for Payer: Cigna Commercial |
$2,134.93
|
| Rate for Payer: First Health Commercial |
$2,443.59
|
| Rate for Payer: Humana Commercial |
$2,186.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,109.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,898.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$771.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,263.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,929.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,057.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,237.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,774.82
|
| Rate for Payer: PHCS Commercial |
$2,469.31
|
| Rate for Payer: United Healthcare All Payer |
$2,263.54
|
|
|
CORRECT SKN COLOR 6.1-20.0C(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
761P0109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.04 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$200.57
|
| Rate for Payer: Ambetter Exchange |
$123.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$123.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$123.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$147.65
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$320.43
|
| Rate for Payer: Healthspan PPO |
$232.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$123.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.04
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.95
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$123.04
|
|
|
CORRECT SKN COLOR 6.1-20.0C(T
|
Facility
|
OP
|
$1,272.20
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
761T0109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$437.51 |
| Max. Negotiated Rate |
$1,221.31 |
| Rate for Payer: Aetna Commercial |
$979.59
|
| Rate for Payer: Anthem Medicaid |
$437.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$565.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$992.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$791.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$763.56
|
| Rate for Payer: Cash Price |
$636.10
|
| Rate for Payer: Cash Price |
$636.10
|
| Rate for Payer: Cigna Commercial |
$1,055.93
|
| Rate for Payer: First Health Commercial |
$1,208.59
|
| Rate for Payer: Humana Commercial |
$1,081.37
|
| Rate for Payer: Humana KY Medicaid |
$437.51
|
| Rate for Payer: Humana Medicare Advantage |
$565.60
|
| Rate for Payer: Kentucky WC Medicaid |
$441.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,043.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$938.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$678.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$446.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,119.54
|
| Rate for Payer: Ohio Health Group HMO |
$954.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,106.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$877.82
|
| Rate for Payer: PHCS Commercial |
$1,221.31
|
| Rate for Payer: United Healthcare All Payer |
$1,119.54
|
|
|
CORRECT SKN COLOR 6.1-20.0C(T
|
Facility
|
IP
|
$1,272.20
|
|
|
Service Code
|
HCPCS 11921
|
| Hospital Charge Code |
761T0109
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$381.66 |
| Max. Negotiated Rate |
$1,221.31 |
| Rate for Payer: Aetna Commercial |
$979.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$992.32
|
| Rate for Payer: Cash Price |
$636.10
|
| Rate for Payer: Cigna Commercial |
$1,055.93
|
| Rate for Payer: First Health Commercial |
$1,208.59
|
| Rate for Payer: Humana Commercial |
$1,081.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,043.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$938.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$381.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,119.54
|
| Rate for Payer: Ohio Health Group HMO |
$954.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,106.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$877.82
|
| Rate for Payer: PHCS Commercial |
$1,221.31
|
| Rate for Payer: United Healthcare All Payer |
$1,119.54
|
|
|
CORRHLLXVALGWSESMDCWPRXMETROST
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
76101003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.15
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
CORRHLLXVALGWSESMDCWPRXMETROST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
761P1003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$1,003.40 |
| Rate for Payer: Ambetter Exchange |
$567.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$449.70
|
| Rate for Payer: Anthem Medicaid |
$734.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$567.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$567.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$680.53
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$1,003.40
|
| Rate for Payer: Humana Medicaid |
$734.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$705.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$567.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$749.08
|
| Rate for Payer: Molina Healthcare Passport |
$734.39
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$737.24
|
| Rate for Payer: UHCCP Medicaid |
$472.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$741.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$567.11
|
|
|
CORRHLLXVALGWSESMDCWPRXMETROST
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
76101003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$1,003.40 |
| Rate for Payer: Ambetter Exchange |
$567.11
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$449.70
|
| Rate for Payer: Anthem Medicaid |
$734.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$567.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$567.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$680.53
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$1,003.40
|
| Rate for Payer: Humana Medicaid |
$734.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$705.91
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$567.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$749.08
|
| Rate for Payer: Molina Healthcare Passport |
$734.39
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$737.24
|
| Rate for Payer: UHCCP Medicaid |
$472.19
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$741.73
|
| Rate for Payer: Wellcare Medicare Advantage |
$567.11
|
|
|
CORRHLLXVALGWSESMDCWPRXMETROST
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 28295
|
| Hospital Charge Code |
76101003
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$252.77 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$507.15
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
CORR H/V WWO SESMDC W/MET OSTE
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 28296
|
| Hospital Charge Code |
76101004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.31 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$827.66
|
| Rate for Payer: Ambetter Exchange |
$489.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$314.31
|
| Rate for Payer: Anthem Medicaid |
$515.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$489.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$489.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$587.76
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$964.61
|
| Rate for Payer: Healthspan PPO |
$933.42
|
| Rate for Payer: Humana Medicaid |
$515.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$489.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.41
|
| Rate for Payer: Molina Healthcare Passport |
$515.11
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$636.74
|
| Rate for Payer: UHCCP Medicaid |
$330.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$489.80
|
|
|
CORR H/V WWO SESMDC W/MET OSTE
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 28296
|
| Hospital Charge Code |
76101004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
CORR H/V WWO SESMDC W/MET OSTE
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 28296
|
| Hospital Charge Code |
761P1004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$314.31 |
| Max. Negotiated Rate |
$1,020.00 |
| Rate for Payer: Aetna Commercial |
$827.66
|
| Rate for Payer: Ambetter Exchange |
$489.80
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$314.31
|
| Rate for Payer: Anthem Medicaid |
$515.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$489.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$489.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$587.76
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$964.61
|
| Rate for Payer: Healthspan PPO |
$933.42
|
| Rate for Payer: Humana Medicaid |
$515.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$649.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$489.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$525.41
|
| Rate for Payer: Molina Healthcare Passport |
$515.11
|
| Rate for Payer: Multiplan PHCS |
$1,020.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$636.74
|
| Rate for Payer: UHCCP Medicaid |
$330.03
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$520.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$489.80
|
|
|
CORR H/V WWO SESMDC W/MET OSTE
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS 28296
|
| Hospital Charge Code |
76101004
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$584.63 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
CORRJ HALUX RIGDUS W/O IMPL(P
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
761P1002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.42 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$830.34
|
| Rate for Payer: Ambetter Exchange |
$439.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$233.42
|
| Rate for Payer: Anthem Medicaid |
$284.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$439.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$439.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$526.97
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$905.96
|
| Rate for Payer: Healthspan PPO |
$921.30
|
| Rate for Payer: Humana Medicaid |
$284.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$439.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$439.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.46
|
| Rate for Payer: Molina Healthcare Passport |
$284.76
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$570.88
|
| Rate for Payer: UHCCP Medicaid |
$245.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$439.14
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Facility
|
IP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
76101002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$1,680.00 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Facility
|
OP
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
76101002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$601.83 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,347.50
|
| Rate for Payer: Anthem Medicaid |
$601.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$1,452.50
|
| Rate for Payer: First Health Commercial |
$1,662.50
|
| Rate for Payer: Humana Commercial |
$1,487.50
|
| Rate for Payer: Humana KY Medicaid |
$601.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$607.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,291.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,312.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,522.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.50
|
| Rate for Payer: PHCS Commercial |
$1,680.00
|
| Rate for Payer: United Healthcare All Payer |
$1,540.00
|
|
|
CORRJ HALUX RIGDUS W/O IMPLT
|
Professional
|
Both
|
$1,750.00
|
|
|
Service Code
|
HCPCS 28289
|
| Hospital Charge Code |
76101002
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$233.42 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$830.34
|
| Rate for Payer: Ambetter Exchange |
$439.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$233.42
|
| Rate for Payer: Anthem Medicaid |
$284.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$439.14
|
| Rate for Payer: Buckeye Medicare Advantage |
$439.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$526.97
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cash Price |
$875.00
|
| Rate for Payer: Cigna Commercial |
$905.96
|
| Rate for Payer: Healthspan PPO |
$921.30
|
| Rate for Payer: Humana Medicaid |
$284.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$683.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$439.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$439.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.46
|
| Rate for Payer: Molina Healthcare Passport |
$284.76
|
| Rate for Payer: Multiplan PHCS |
$1,050.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$570.88
|
| Rate for Payer: UHCCP Medicaid |
$245.09
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$439.14
|
|
|
CORSAIR MICROCATHETER 135CM
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
