|
DECOMPRSN FASCTMY, LEG
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
HCPCS 27893
|
| Hospital Charge Code |
76100962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$278.56 |
| Max. Negotiated Rate |
$9,240.92 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem Medicaid |
$278.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,600.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| 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 |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Humana KY Medicaid |
$278.56
|
| Rate for Payer: Humana Medicare Advantage |
$6,600.66
|
| Rate for Payer: Kentucky WC Medicaid |
$281.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,920.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.90
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
DECOMPRSN FASCTMY, LEG
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
HCPCS 27893
|
| Hospital Charge Code |
76100962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$243.00 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$631.80
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$672.30
|
| Rate for Payer: First Health Commercial |
$769.50
|
| Rate for Payer: Humana Commercial |
$688.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$664.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$597.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$712.80
|
| Rate for Payer: Ohio Health Group HMO |
$607.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$704.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.90
|
| Rate for Payer: PHCS Commercial |
$777.60
|
| Rate for Payer: United Healthcare All Payer |
$712.80
|
|
|
DECOMPRSN FASCTMY, LEG
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 27893
|
| Hospital Charge Code |
76100962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.71 |
| Max. Negotiated Rate |
$873.03 |
| Rate for Payer: Aetna Commercial |
$813.23
|
| Rate for Payer: Ambetter Exchange |
$586.62
|
| Rate for Payer: Anthem Medicaid |
$282.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$586.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$586.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$703.94
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$873.03
|
| Rate for Payer: Healthspan PPO |
$736.61
|
| Rate for Payer: Humana Medicaid |
$282.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$730.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$586.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.36
|
| Rate for Payer: Molina Healthcare Passport |
$282.71
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$762.61
|
| Rate for Payer: UHCCP Medicaid |
$283.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$586.62
|
|
|
DECOMPRSN FASCTMY, LEG(P
|
Professional
|
Both
|
$810.00
|
|
|
Service Code
|
HCPCS 27893
|
| Hospital Charge Code |
761P0962
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$282.71 |
| Max. Negotiated Rate |
$873.03 |
| Rate for Payer: Aetna Commercial |
$813.23
|
| Rate for Payer: Ambetter Exchange |
$586.62
|
| Rate for Payer: Anthem Medicaid |
$282.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$586.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$586.62
|
| Rate for Payer: CareSource Just4Me Medicare |
$703.94
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$873.03
|
| Rate for Payer: Healthspan PPO |
$736.61
|
| Rate for Payer: Humana Medicaid |
$282.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$730.90
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$586.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.36
|
| Rate for Payer: Molina Healthcare Passport |
$282.71
|
| Rate for Payer: Multiplan PHCS |
$486.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$762.61
|
| Rate for Payer: UHCCP Medicaid |
$283.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$586.62
|
|
|
DECOMP THIGH/KNEE
|
Facility
|
OP
|
$3,741.00
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
76100855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,286.53 |
| Max. Negotiated Rate |
$3,591.36 |
| Rate for Payer: Aetna Commercial |
$2,880.57
|
| Rate for Payer: Anthem Medicaid |
$1,286.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$3,105.03
|
| Rate for Payer: First Health Commercial |
$3,553.95
|
| Rate for Payer: Humana Commercial |
$3,179.85
|
| Rate for Payer: Humana KY Medicaid |
$1,286.53
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,299.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,067.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,312.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,292.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,254.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,581.29
|
| Rate for Payer: PHCS Commercial |
$3,591.36
|
| Rate for Payer: United Healthcare All Payer |
$3,292.08
|
|
|
DECOMP THIGH/KNEE
|
Facility
|
IP
|
$3,741.00
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
76100855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,122.30 |
| Max. Negotiated Rate |
$3,591.36 |
| Rate for Payer: Aetna Commercial |
$2,880.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.98
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$3,105.03
|
| Rate for Payer: First Health Commercial |
$3,553.95
|
| Rate for Payer: Humana Commercial |
$3,179.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,067.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,292.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,254.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,581.29
|
| Rate for Payer: PHCS Commercial |
$3,591.36
|
| Rate for Payer: United Healthcare All Payer |
$3,292.08
|
|
|
DECOMP THIGH/KNEE
|
Professional
|
Both
|
$3,741.00
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
76100855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$2,244.60 |
| Rate for Payer: Aetna Commercial |
$869.21
|
| Rate for Payer: Ambetter Exchange |
$628.97
|
| Rate for Payer: Anthem Medicaid |
$389.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$628.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$628.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.76
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$954.16
|
| Rate for Payer: Healthspan PPO |
$787.32
|
| Rate for Payer: Humana Medicaid |
$389.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$774.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$628.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.12
|
| Rate for Payer: Molina Healthcare Passport |
$389.33
|
| Rate for Payer: Multiplan PHCS |
$2,244.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$817.66
|
| Rate for Payer: UHCCP Medicaid |
$1,309.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$628.97
|
|
|
DECOMP THIGH/KNEE(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
761P0855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$869.21
|
| Rate for Payer: Ambetter Exchange |
$628.97
|
| Rate for Payer: Anthem Medicaid |
$389.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$628.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$628.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$754.76
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$954.16
|
| Rate for Payer: Healthspan PPO |
$787.32
|
| Rate for Payer: Humana Medicaid |
$389.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$774.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$628.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$397.12
|
| Rate for Payer: Molina Healthcare Passport |
$389.33
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$817.66
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$628.97
|
|
|
DECOMP THIGH/KNEE(T
|
Facility
|
OP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
761T0855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.51 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem Medicaid |
$667.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Humana KY Medicaid |
$667.51
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$674.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$680.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
DECOMP THIGH/KNEE(T
|
Facility
|
IP
|
$1,941.00
|
|
|
Service Code
|
HCPCS 27498
|
| Hospital Charge Code |
761T0855
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$582.30 |
| Max. Negotiated Rate |
$1,863.36 |
| Rate for Payer: Aetna Commercial |
$1,494.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$1,611.03
|
| Rate for Payer: First Health Commercial |
$1,843.95
|
| Rate for Payer: Humana Commercial |
$1,649.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,591.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,455.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,688.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.29
|
| Rate for Payer: PHCS Commercial |
$1,863.36
|
| Rate for Payer: United Healthcare All Payer |
$1,708.08
|
|
|
DECORTICATION
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32220
|
| Hospital Charge Code |
76101183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,654.83 |
| Rate for Payer: Aetna Commercial |
$2,654.83
|
| Rate for Payer: Ambetter Exchange |
$1,505.90
|
| Rate for Payer: Anthem Medicaid |
$1,014.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,505.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,505.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,807.08
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,507.04
|
| Rate for Payer: Healthspan PPO |
$2,072.82
|
| Rate for Payer: Humana Medicaid |
$1,014.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,201.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,505.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,034.51
|
| Rate for Payer: Molina Healthcare Passport |
$1,014.23
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,957.67
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,024.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,505.90
|
|
|
DECORTICATION
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32220
|
| Hospital Charge Code |
76101183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
DECORTICATION
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32220
|
| Hospital Charge Code |
76101183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$750.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,175.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
DECORTICATION AND PARIETAL PLE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32320
|
| Hospital Charge Code |
761P1185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$2,660.22 |
| Rate for Payer: Aetna Commercial |
$2,660.22
|
| Rate for Payer: Ambetter Exchange |
$1,511.46
|
| Rate for Payer: Anthem Medicaid |
$1,130.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,511.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,511.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,813.75
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,497.39
|
| Rate for Payer: Healthspan PPO |
$2,077.03
|
| Rate for Payer: Humana Medicaid |
$1,130.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,211.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,511.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,152.62
|
| Rate for Payer: Molina Healthcare Passport |
$1,130.02
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,964.90
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,141.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,511.46
|
|
|
DECORTICATION AND PARIETAL PLE
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32320
|
| Hospital Charge Code |
76101185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem Medicaid |
$1,031.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Humana KY Medicaid |
$1,031.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,042.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,052.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
DECORTICATION AND PARIETAL PLE
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32320
|
| Hospital Charge Code |
76101185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$900.00 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$2,310.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,340.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,490.00
|
| Rate for Payer: First Health Commercial |
$2,850.00
|
| Rate for Payer: Humana Commercial |
$2,550.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,460.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,214.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$900.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,610.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.00
|
| Rate for Payer: PHCS Commercial |
$2,880.00
|
| Rate for Payer: United Healthcare All Payer |
$2,640.00
|
|
|
DECORTICATION AND PARIETAL PLE
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 32320
|
| Hospital Charge Code |
76101185
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,050.00 |
| Max. Negotiated Rate |
$2,660.22 |
| Rate for Payer: Aetna Commercial |
$2,660.22
|
| Rate for Payer: Ambetter Exchange |
$1,511.46
|
| Rate for Payer: Anthem Medicaid |
$1,130.02
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,511.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,511.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,813.75
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$2,497.39
|
| Rate for Payer: Healthspan PPO |
$2,077.03
|
| Rate for Payer: Humana Medicaid |
$1,130.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,211.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,511.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,511.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,152.62
|
| Rate for Payer: Molina Healthcare Passport |
$1,130.02
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,964.90
|
| Rate for Payer: UHCCP Medicaid |
$1,050.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,141.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,511.46
|
|
|
DECORTICATION(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 32220
|
| Hospital Charge Code |
761P1183
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,654.83 |
| Rate for Payer: Aetna Commercial |
$2,654.83
|
| Rate for Payer: Ambetter Exchange |
$1,505.90
|
| Rate for Payer: Anthem Medicaid |
$1,014.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,505.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,505.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,807.08
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,507.04
|
| Rate for Payer: Healthspan PPO |
$2,072.82
|
| Rate for Payer: Humana Medicaid |
$1,014.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,201.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,505.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,034.51
|
| Rate for Payer: Molina Healthcare Passport |
$1,014.23
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,957.67
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,024.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,505.90
|
|
|
DECORTICATION PULMONARY
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
76101184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DECORTICATION PULMONARY
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
76101184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,646.42 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Ambetter Exchange |
$938.65
|
| Rate for Payer: Anthem Medicaid |
$728.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$938.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$938.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,126.38
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,544.28
|
| Rate for Payer: Healthspan PPO |
$1,285.48
|
| Rate for Payer: Humana Medicaid |
$728.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,376.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$938.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$742.59
|
| Rate for Payer: Molina Healthcare Passport |
$728.03
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,220.24
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$735.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$938.65
|
|
|
DECORTICATION PULMONARY
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
76101184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
DECORTICATION PULMONARY(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 32225
|
| Hospital Charge Code |
761P1184
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$1,646.42 |
| Rate for Payer: Aetna Commercial |
$1,646.42
|
| Rate for Payer: Ambetter Exchange |
$938.65
|
| Rate for Payer: Anthem Medicaid |
$728.03
|
| Rate for Payer: Buckeye Individual/Medicaid |
$938.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$938.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,126.38
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,544.28
|
| Rate for Payer: Healthspan PPO |
$1,285.48
|
| Rate for Payer: Humana Medicaid |
$728.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,376.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$938.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$742.59
|
| Rate for Payer: Molina Healthcare Passport |
$728.03
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,220.24
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$735.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$938.65
|
|
|
DEFEROXAMINE 500mg(2gm) IM SDV
|
Facility
|
IP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.93
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFEROXAMINE 500mg(2gm) IM SDV
|
Facility
|
OP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004297
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem Medicaid |
$77.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Humana KY Medicaid |
$77.22
|
| Rate for Payer: Kentucky WC Medicaid |
$78.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.93
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
|
DEFEROXAMINE 500mg(2gm) IV SDV
|
Facility
|
OP
|
$224.54
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
25004296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Anthem Medicaid |
$77.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.14
|
| Rate for Payer: Cash Price |
$112.27
|
| Rate for Payer: Cigna Commercial |
$186.37
|
| Rate for Payer: First Health Commercial |
$213.31
|
| Rate for Payer: Humana Commercial |
$190.86
|
| Rate for Payer: Humana KY Medicaid |
$77.22
|
| Rate for Payer: Kentucky WC Medicaid |
$78.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$165.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$78.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$197.60
|
| Rate for Payer: Ohio Health Group HMO |
$168.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$179.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$154.93
|
| Rate for Payer: PHCS Commercial |
$215.56
|
| Rate for Payer: United Healthcare All Payer |
$197.60
|
|
