|
FIRVANQ 250MCG/5ML ORAL SOL
|
Facility
|
IP
|
$22.45
|
|
|
Service Code
|
NDC 65628020605
|
| Hospital Charge Code |
25003066
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$17.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.51
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna Commercial |
$18.63
|
| Rate for Payer: First Health Commercial |
$21.33
|
| Rate for Payer: Humana Commercial |
$19.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.76
|
| Rate for Payer: Ohio Health Group HMO |
$16.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.96
|
| Rate for Payer: PHCS Commercial |
$21.55
|
| Rate for Payer: United Healthcare All Payer |
$19.76
|
|
|
FISSURECTOMY W WO SPHINECTOM(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 46200
|
| Hospital Charge Code |
761P1915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.90 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$194.43
|
| Rate for Payer: Anthem Medicaid |
$192.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$376.74
|
| Rate for Payer: Healthspan PPO |
$446.94
|
| Rate for Payer: Humana Medicaid |
$192.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$388.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.76
|
| Rate for Payer: Molina Healthcare Passport |
$192.90
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$204.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.83
|
|
|
FISSURECTOMY W WO SPHINECTOMY
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 46200
|
| Hospital Charge Code |
76101915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.90 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$194.43
|
| Rate for Payer: Anthem Medicaid |
$192.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$650.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$376.74
|
| Rate for Payer: Healthspan PPO |
$446.94
|
| Rate for Payer: Humana Medicaid |
$192.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$388.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$196.76
|
| Rate for Payer: Molina Healthcare Passport |
$192.90
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$455.00
|
| Rate for Payer: UHCCP Medicaid |
$204.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$194.83
|
|
|
FISSURECTOMY W WO SPHINECTOMY
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 46200
|
| Hospital Charge Code |
76101915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
FISSURECTOMY W WO SPHINECTOMY
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 46200
|
| Hospital Charge Code |
76101915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$84.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$201.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
FISTULA REPAIR RECTO VAG
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57300
|
| Hospital Charge Code |
76102188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$3,784.94 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,703.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,784.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,649.77
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$2,703.53
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,244.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
FISTULA REPAIR RECTO VAG
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57300
|
| Hospital Charge Code |
76102188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.33 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$798.65
|
| Rate for Payer: Anthem Medicaid |
$452.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$763.26
|
| Rate for Payer: Healthspan PPO |
$773.30
|
| Rate for Payer: Humana Medicaid |
$452.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$709.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.38
|
| Rate for Payer: Molina Healthcare Passport |
$452.33
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.85
|
|
|
FISTULA REPAIR RECTO VAG
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57300
|
| Hospital Charge Code |
76102188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
FISTULA REPAIR RECTO VAG(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 57300
|
| Hospital Charge Code |
761P2188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$452.33 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$798.65
|
| Rate for Payer: Anthem Medicaid |
$452.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$763.26
|
| Rate for Payer: Healthspan PPO |
$773.30
|
| Rate for Payer: Humana Medicaid |
$452.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$709.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$461.38
|
| Rate for Payer: Molina Healthcare Passport |
$452.33
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$630.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$456.85
|
|
|
FISTULA REPAIR URETHROVAG
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 57310
|
| Hospital Charge Code |
76102190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.53 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$734.44
|
| Rate for Payer: Anthem Medicaid |
$306.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$677.56
|
| Rate for Payer: Healthspan PPO |
$711.12
|
| Rate for Payer: Humana Medicaid |
$306.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$599.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.66
|
| Rate for Payer: Molina Healthcare Passport |
$306.53
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.60
|
|
|
FISTULA REPAIR URETHROVAG
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 57310
|
| Hospital Charge Code |
76102190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
FISTULA REPAIR URETHROVAG
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 57310
|
| Hospital Charge Code |
76102190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$260.00 |
| Max. Negotiated Rate |
$9,148.36 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,534.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,148.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,821.63
|
| Rate for Payer: Cash Price |
$1,000.00
|
| 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: Humana Medicare Advantage |
$6,534.54
|
| 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 |
$7,841.45
|
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$620.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
FISTULA REPAIR URETHROVAG(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 57310
|
| Hospital Charge Code |
761P2190
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$306.53 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Aetna Commercial |
$734.44
|
| Rate for Payer: Anthem Medicaid |
$306.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$677.56
|
| Rate for Payer: Healthspan PPO |
$711.12
|
| Rate for Payer: Humana Medicaid |
$306.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$599.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$312.66
|
| Rate for Payer: Molina Healthcare Passport |
$306.53
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$309.60
|
|
|
FIXATION KT SECONDARY ACL/PCL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
FIXATION KT SECONDARY ACL/PCL
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
FIXATION OF ANKLE JOINT
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 27860
|
| Hospital Charge Code |
76102938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$263.54
|
| Rate for Payer: Anthem Medicaid |
$110.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$388.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$285.54
|
| Rate for Payer: Healthspan PPO |
$238.71
|
| Rate for Payer: Humana Medicaid |
$110.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$216.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.27
|
| Rate for Payer: Molina Healthcare Passport |
$110.07
|
| Rate for Payer: Multiplan PHCS |
$232.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.60
|
| Rate for Payer: UHCCP Medicaid |
$135.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.17
|
|
|
FIXATION OF ANKLE JOINT
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 27860
|
| Hospital Charge Code |
76102938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
FIXATION OF ANKLE JOINT
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 27860
|
| Hospital Charge Code |
76102938
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
FIXATION OF KNEE JOINT
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
76100878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Anthem Medicaid |
$102.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$232.52
|
| Rate for Payer: Healthspan PPO |
$192.82
|
| Rate for Payer: Humana Medicaid |
$102.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.58
|
| Rate for Payer: Molina Healthcare Passport |
$102.53
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.56
|
|
|
FIXATION OF KNEE JOINT
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
76100878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
FIXATION OF KNEE JOINT
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
76100878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$462.00
|
| Rate for Payer: Anthem Medicaid |
$206.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$468.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$498.00
|
| Rate for Payer: First Health Commercial |
$570.00
|
| Rate for Payer: Humana Commercial |
$510.00
|
| Rate for Payer: Humana KY Medicaid |
$206.34
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$492.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$442.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$210.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$528.00
|
| Rate for Payer: Ohio Health Group HMO |
$450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.00
|
| Rate for Payer: PHCS Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Payer |
$528.00
|
|
|
FIXATION OF KNEE JOINT(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 27570
|
| Hospital Charge Code |
761P0878
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.53 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$212.88
|
| Rate for Payer: Anthem Medicaid |
$102.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$600.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$232.52
|
| Rate for Payer: Healthspan PPO |
$192.82
|
| Rate for Payer: Humana Medicaid |
$102.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$182.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.58
|
| Rate for Payer: Molina Healthcare Passport |
$102.53
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$420.00
|
| Rate for Payer: UHCCP Medicaid |
$210.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.56
|
|
|
FIXED CORE J .025 150CM
|
Facility
|
OP
|
$155.56
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$149.34 |
| Rate for Payer: Aetna Commercial |
$119.78
|
| Rate for Payer: Anthem Medicaid |
$53.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.34
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cigna Commercial |
$129.11
|
| Rate for Payer: First Health Commercial |
$147.78
|
| Rate for Payer: Humana Commercial |
$132.23
|
| Rate for Payer: Humana KY Medicaid |
$53.50
|
| Rate for Payer: Kentucky WC Medicaid |
$54.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.89
|
| Rate for Payer: Ohio Health Group HMO |
$116.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.22
|
| Rate for Payer: PHCS Commercial |
$149.34
|
| Rate for Payer: United Healthcare All Payer |
$136.89
|
|
|
FIXED CORE J .025 150CM
|
Facility
|
IP
|
$155.56
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$149.34 |
| Rate for Payer: Aetna Commercial |
$119.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.34
|
| Rate for Payer: Cash Price |
$77.78
|
| Rate for Payer: Cigna Commercial |
$129.11
|
| Rate for Payer: First Health Commercial |
$147.78
|
| Rate for Payer: Humana Commercial |
$132.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$127.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$114.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$136.89
|
| Rate for Payer: Ohio Health Group HMO |
$116.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.22
|
| Rate for Payer: PHCS Commercial |
$149.34
|
| Rate for Payer: United Healthcare All Payer |
$136.89
|
|
|
FIXED CORE J 150CM
|
Facility
|
IP
|
$144.41
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$138.63 |
| Rate for Payer: Aetna Commercial |
$111.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.64
|
| Rate for Payer: Cash Price |
$72.21
|
| Rate for Payer: Cigna Commercial |
$119.86
|
| Rate for Payer: First Health Commercial |
$137.19
|
| Rate for Payer: Humana Commercial |
$122.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$127.08
|
| Rate for Payer: Ohio Health Group HMO |
$108.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$28.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44.77
|
| Rate for Payer: PHCS Commercial |
$138.63
|
| Rate for Payer: United Healthcare All Payer |
$127.08
|
|
