|
AMPLATZ SS 145CM
|
Facility
|
IP
|
$530.01
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$508.81 |
| Rate for Payer: Aetna Commercial |
$408.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$413.41
|
| Rate for Payer: Cash Price |
$265.01
|
| Rate for Payer: Cigna Commercial |
$439.91
|
| Rate for Payer: First Health Commercial |
$503.51
|
| Rate for Payer: Humana Commercial |
$450.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$434.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$466.41
|
| Rate for Payer: Ohio Health Group HMO |
$397.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$365.71
|
| Rate for Payer: PHCS Commercial |
$508.81
|
| Rate for Payer: United Healthcare All Payer |
$466.41
|
|
|
AMPLATZ STRAIGHT 0.35 75CM
|
Facility
|
OP
|
$540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.19
|
| Rate for Payer: Anthem Medicaid |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.43
|
| Rate for Payer: Humana KY Medicaid |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$187.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.94
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
AMPLATZ STRAIGHT 0.35 75CM
|
Facility
|
IP
|
$540.50
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$416.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.59
|
| Rate for Payer: Cash Price |
$270.25
|
| Rate for Payer: Cigna Commercial |
$448.62
|
| Rate for Payer: First Health Commercial |
$513.48
|
| Rate for Payer: Humana Commercial |
$459.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$398.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$475.64
|
| Rate for Payer: Ohio Health Group HMO |
$405.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.94
|
| Rate for Payer: PHCS Commercial |
$518.88
|
| Rate for Payer: United Healthcare All Payer |
$475.64
|
|
|
AMPLATZ WIRE PTFE .035 STR
|
Facility
|
OP
|
$533.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$512.04 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Anthem Medicaid |
$183.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.03
|
| Rate for Payer: Cash Price |
$266.69
|
| Rate for Payer: Cigna Commercial |
$442.70
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: Humana Commercial |
$453.36
|
| Rate for Payer: Humana KY Medicaid |
$183.43
|
| Rate for Payer: Kentucky WC Medicaid |
$185.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.37
|
| Rate for Payer: Ohio Health Group HMO |
$400.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.03
|
| Rate for Payer: PHCS Commercial |
$512.04
|
| Rate for Payer: United Healthcare All Payer |
$469.37
|
|
|
AMPLATZ WIRE PTFE .035 STR
|
Facility
|
IP
|
$533.37
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$512.04 |
| Rate for Payer: Aetna Commercial |
$410.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.03
|
| Rate for Payer: Cash Price |
$266.69
|
| Rate for Payer: Cigna Commercial |
$442.70
|
| Rate for Payer: First Health Commercial |
$506.70
|
| Rate for Payer: Humana Commercial |
$453.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$393.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.37
|
| Rate for Payer: Ohio Health Group HMO |
$400.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$426.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.03
|
| Rate for Payer: PHCS Commercial |
$512.04
|
| Rate for Payer: United Healthcare All Payer |
$469.37
|
|
|
AMPUL LANOXIN (DIGOXI .5MG/2ML
|
Facility
|
IP
|
$112.50
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
25002020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$86.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.75
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna Commercial |
$93.38
|
| Rate for Payer: First Health Commercial |
$106.88
|
| Rate for Payer: Humana Commercial |
$95.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.00
|
| Rate for Payer: Ohio Health Group HMO |
$84.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.62
|
| Rate for Payer: PHCS Commercial |
$108.00
|
| Rate for Payer: United Healthcare All Payer |
$99.00
|
|
|
AMPUL LANOXIN (DIGOXI .5MG/2ML
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
25002020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$86.62
|
| Rate for Payer: Anthem Medicaid |
$38.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$87.75
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cigna Commercial |
$93.38
|
| Rate for Payer: First Health Commercial |
$106.88
|
| Rate for Payer: Humana Commercial |
$95.62
|
| Rate for Payer: Humana KY Medicaid |
$38.69
|
| Rate for Payer: Kentucky WC Medicaid |
$39.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$92.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$83.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$99.00
|
| Rate for Payer: Ohio Health Group HMO |
$84.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.62
|
| Rate for Payer: PHCS Commercial |
$108.00
|
| Rate for Payer: United Healthcare All Payer |
$99.00
|
|
|
AMPUTATE LEG AT THIGH
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
HCPCS 27592
|
| Hospital Charge Code |
76100880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.00 |
| Max. Negotiated Rate |
$854.40 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Anthem Medicaid |
$306.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.20
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$738.70
|
| Rate for Payer: First Health Commercial |
$845.50
|
| Rate for Payer: Humana Commercial |
$756.50
|
| Rate for Payer: Humana KY Medicaid |
$306.07
|
| Rate for Payer: Kentucky WC Medicaid |
$309.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$729.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$656.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$312.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$783.20
|
| Rate for Payer: Ohio Health Group HMO |
$667.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.10
|
| Rate for Payer: PHCS Commercial |
$854.40
|
| Rate for Payer: United Healthcare All Payer |
$783.20
|
|
|
AMPUTATE LEG AT THIGH
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
HCPCS 27592
|
| Hospital Charge Code |
76100880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$267.00 |
| Max. Negotiated Rate |
$854.40 |
| Rate for Payer: Aetna Commercial |
$685.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$694.20
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$738.70
|
| Rate for Payer: First Health Commercial |
$845.50
|
| Rate for Payer: Humana Commercial |
$756.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$729.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$656.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$783.20
|
| Rate for Payer: Ohio Health Group HMO |
$667.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.10
|
| Rate for Payer: PHCS Commercial |
$854.40
|
| Rate for Payer: United Healthcare All Payer |
$783.20
|
|
|
AMPUTATE LEG AT THIGH
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 27592
|
| Hospital Charge Code |
76100880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$1,118.96 |
| Rate for Payer: Aetna Commercial |
$1,043.25
|
| Rate for Payer: Ambetter Exchange |
$640.32
|
| Rate for Payer: Anthem Medicaid |
$513.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$640.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$768.38
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$1,118.96
|
| Rate for Payer: Healthspan PPO |
$944.97
|
| Rate for Payer: Humana Medicaid |
$513.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$640.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.67
|
| Rate for Payer: Molina Healthcare Passport |
$513.40
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$832.42
|
| Rate for Payer: UHCCP Medicaid |
$311.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$640.32
|
|
|
AMPUTATE LEG AT THIGH(P
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
HCPCS 27592
|
| Hospital Charge Code |
761P0880
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$1,118.96 |
| Rate for Payer: Aetna Commercial |
$1,043.25
|
| Rate for Payer: Ambetter Exchange |
$640.32
|
| Rate for Payer: Anthem Medicaid |
$513.40
|
| Rate for Payer: Buckeye Individual/Medicaid |
$640.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$640.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$768.38
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cash Price |
$445.00
|
| Rate for Payer: Cigna Commercial |
$1,118.96
|
| Rate for Payer: Healthspan PPO |
$944.97
|
| Rate for Payer: Humana Medicaid |
$513.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$892.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$640.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$523.67
|
| Rate for Payer: Molina Healthcare Passport |
$513.40
|
| Rate for Payer: Multiplan PHCS |
$534.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$832.42
|
| Rate for Payer: UHCCP Medicaid |
$311.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$518.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$640.32
|
|
|
AMPUTATE METACARPAL BONE
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
76100755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.23 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem Medicaid |
$311.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| 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 |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Humana KY Medicaid |
$311.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$314.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$317.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.45
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
AMPUTATE METACARPAL BONE
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
76100755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.75 |
| Max. Negotiated Rate |
$1,189.35 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Ambetter Exchange |
$710.56
|
| Rate for Payer: Anthem Medicaid |
$371.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$710.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$852.67
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$1,189.35
|
| Rate for Payer: Healthspan PPO |
$915.07
|
| Rate for Payer: Humana Medicaid |
$371.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$869.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$710.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.12
|
| Rate for Payer: Molina Healthcare Passport |
$371.69
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$923.73
|
| Rate for Payer: UHCCP Medicaid |
$316.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$710.56
|
|
|
AMPUTATE METACARPAL BONE
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
76100755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.50 |
| Max. Negotiated Rate |
$868.80 |
| Rate for Payer: Aetna Commercial |
$696.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$705.90
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$751.15
|
| Rate for Payer: First Health Commercial |
$859.75
|
| Rate for Payer: Humana Commercial |
$769.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$742.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$667.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$271.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$796.40
|
| Rate for Payer: Ohio Health Group HMO |
$678.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$724.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$787.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.45
|
| Rate for Payer: PHCS Commercial |
$868.80
|
| Rate for Payer: United Healthcare All Payer |
$796.40
|
|
|
AMPUTATE METACARPAL BONE(P
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 26910
|
| Hospital Charge Code |
761P0755
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$316.75 |
| Max. Negotiated Rate |
$1,189.35 |
| Rate for Payer: Aetna Commercial |
$1,010.24
|
| Rate for Payer: Ambetter Exchange |
$710.56
|
| Rate for Payer: Anthem Medicaid |
$371.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$710.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$710.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$852.67
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cash Price |
$452.50
|
| Rate for Payer: Cigna Commercial |
$1,189.35
|
| Rate for Payer: Healthspan PPO |
$915.07
|
| Rate for Payer: Humana Medicaid |
$371.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$869.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$710.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$710.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$379.12
|
| Rate for Payer: Molina Healthcare Passport |
$371.69
|
| Rate for Payer: Multiplan PHCS |
$543.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$923.73
|
| Rate for Payer: UHCCP Medicaid |
$316.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$375.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$710.56
|
|
|
AMPUTAT FNGTHMBPRISECJNTPHLN(P
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
761P0756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.29 |
| Max. Negotiated Rate |
$1,001.82 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Ambetter Exchange |
$652.28
|
| Rate for Payer: Anthem Medicaid |
$218.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$652.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$652.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$782.74
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,001.82
|
| Rate for Payer: Healthspan PPO |
$778.78
|
| Rate for Payer: Humana Medicaid |
$218.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$772.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$652.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.66
|
| Rate for Payer: Molina Healthcare Passport |
$218.29
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$847.96
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$652.28
|
|
|
AMPUTAT FNGTHMBPRISECJNTPHLNX
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
76100756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$507.25 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| 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 |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
AMPUTAT FNGTHMBPRISECJNTPHLNX
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
76100756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$218.29 |
| Max. Negotiated Rate |
$1,001.82 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Ambetter Exchange |
$652.28
|
| Rate for Payer: Anthem Medicaid |
$218.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$652.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$652.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$782.74
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,001.82
|
| Rate for Payer: Healthspan PPO |
$778.78
|
| Rate for Payer: Humana Medicaid |
$218.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$772.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$652.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$222.66
|
| Rate for Payer: Molina Healthcare Passport |
$218.29
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$847.96
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$220.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$652.28
|
|
|
AMPUTAT FNGTHMBPRISECJNTPHLNX
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
76100756
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
AMPUTAT FNGTHMBPRISECJNTPHLNX
|
Facility
|
OP
|
$4,088.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
45000149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,405.86 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Aetna Commercial |
$3,147.76
|
| Rate for Payer: Anthem Medicaid |
$1,405.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.64
|
| 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 |
$2,044.00
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cigna Commercial |
$3,393.04
|
| Rate for Payer: First Health Commercial |
$3,883.60
|
| Rate for Payer: Humana Commercial |
$3,474.80
|
| Rate for Payer: Humana KY Medicaid |
$1,405.86
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,556.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.72
|
| Rate for Payer: PHCS Commercial |
$3,924.48
|
| Rate for Payer: United Healthcare All Payer |
$3,597.44
|
|
|
AMPUTAT FNGTHMBPRISECJNTPHLNX
|
Facility
|
IP
|
$4,088.00
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
45000149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,226.40 |
| Max. Negotiated Rate |
$3,924.48 |
| Rate for Payer: Aetna Commercial |
$3,147.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.64
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Cigna Commercial |
$3,393.04
|
| Rate for Payer: First Health Commercial |
$3,883.60
|
| Rate for Payer: Humana Commercial |
$3,474.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,270.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,556.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.72
|
| Rate for Payer: PHCS Commercial |
$3,924.48
|
| Rate for Payer: United Healthcare All Payer |
$3,597.44
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
|
OP
|
$4,197.13
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,997.95 |
| Max. Negotiated Rate |
$4,197.13 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,997.95
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,197.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,047.23
|
| Rate for Payer: Humana Medicare Advantage |
$2,997.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,597.54
|
|
|
AMPUTATION FOLLOW-UP SURGER(P
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 27884
|
| Hospital Charge Code |
761P0959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.35 |
| Max. Negotiated Rate |
$945.18 |
| Rate for Payer: Aetna Commercial |
$870.89
|
| Rate for Payer: Ambetter Exchange |
$548.58
|
| Rate for Payer: Anthem Medicaid |
$322.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$658.30
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$945.18
|
| Rate for Payer: Healthspan PPO |
$788.84
|
| Rate for Payer: Humana Medicaid |
$322.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.80
|
| Rate for Payer: Molina Healthcare Passport |
$322.35
|
| Rate for Payer: Multiplan PHCS |
$696.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$713.15
|
| Rate for Payer: UHCCP Medicaid |
$406.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.58
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Professional
|
Both
|
$1,160.00
|
|
|
Service Code
|
HCPCS 27884
|
| Hospital Charge Code |
76100959
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$322.35 |
| Max. Negotiated Rate |
$945.18 |
| Rate for Payer: Aetna Commercial |
$870.89
|
| Rate for Payer: Ambetter Exchange |
$548.58
|
| Rate for Payer: Anthem Medicaid |
$322.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$548.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$658.30
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cigna Commercial |
$945.18
|
| Rate for Payer: Healthspan PPO |
$788.84
|
| Rate for Payer: Humana Medicaid |
$322.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$744.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$548.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.58
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$328.80
|
| Rate for Payer: Molina Healthcare Passport |
$322.35
|
| Rate for Payer: Multiplan PHCS |
$696.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$713.15
|
| Rate for Payer: UHCCP Medicaid |
$406.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$325.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$548.58
|
|
|
AMPUTATION FOLLOW-UP SURGERY
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 27594
|
| Hospital Charge Code |
76102752
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$811.87 |
| Rate for Payer: Aetna Commercial |
$750.38
|
| Rate for Payer: Ambetter Exchange |
$479.24
|
| Rate for Payer: Anthem Medicaid |
$299.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$479.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$479.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$575.09
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$811.87
|
| Rate for Payer: Healthspan PPO |
$679.69
|
| Rate for Payer: Humana Medicaid |
$299.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$643.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$479.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$479.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$305.28
|
| Rate for Payer: Molina Healthcare Passport |
$299.29
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$623.01
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$302.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$479.24
|
|
