|
FOLATE
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
30000323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$14.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.70
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$14.70
|
| Rate for Payer: Humana Medicare Advantage |
$14.70
|
| Rate for Payer: Kentucky WC Medicaid |
$14.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
FOLATE
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
30000323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$100.38
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
FOLATE
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 82746
|
| Hospital Charge Code |
30000323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Aetna Commercial |
$24.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$12.95
|
| Rate for Payer: Healthspan PPO |
$15.41
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.82
|
|
|
FOLIC ACID 1 MG TABLE 1MG/1TAB
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
25000699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
FOLIC ACID 1 MG TABLE 1MG/1TAB
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 60687068101
|
| Hospital Charge Code |
25000699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.20 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.41
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cigna Commercial |
$3.63
|
| Rate for Payer: First Health Commercial |
$4.15
|
| Rate for Payer: Humana Commercial |
$3.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.85
|
| Rate for Payer: Ohio Health Group HMO |
$3.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.20
|
| Rate for Payer: United Healthcare All Payer |
$3.85
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$35.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.96
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
51000342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
510P0342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$35.97
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.96
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS(T
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
510T0342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
FOLLOW-UP EXAM FOOT PT LOPS(T
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS G0246
|
| Hospital Charge Code |
510T0342
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
FOLVITE(FOLIC ACID) 50MG/10ML
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
NDC 39822110001
|
| Hospital Charge Code |
25003076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem Medicaid |
$65.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.98
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Humana KY Medicaid |
$65.68
|
| Rate for Payer: Kentucky WC Medicaid |
$66.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.21
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
FOLVITE(FOLIC ACID) 50MG/10ML
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
NDC 39822110001
|
| Hospital Charge Code |
25003076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$183.36 |
| Rate for Payer: Aetna Commercial |
$147.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.98
|
| Rate for Payer: Cash Price |
$95.50
|
| Rate for Payer: Cigna Commercial |
$158.53
|
| Rate for Payer: First Health Commercial |
$181.45
|
| Rate for Payer: Humana Commercial |
$162.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$156.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.08
|
| Rate for Payer: Ohio Health Group HMO |
$143.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.21
|
| Rate for Payer: PHCS Commercial |
$183.36
|
| Rate for Payer: United Healthcare All Payer |
$168.08
|
|
|
FOOT & ANKLE KIT 3CC END 11G
|
Facility
|
IP
|
$14,209.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.28 |
| Max. Negotiated Rate |
$13,641.46 |
| Rate for Payer: Aetna Commercial |
$10,941.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,083.68
|
| Rate for Payer: Cash Price |
$7,104.92
|
| Rate for Payer: Cigna Commercial |
$11,794.18
|
| Rate for Payer: First Health Commercial |
$13,499.36
|
| Rate for Payer: Humana Commercial |
$12,078.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,652.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,486.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,504.67
|
| Rate for Payer: Ohio Health Group HMO |
$10,657.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,405.05
|
| Rate for Payer: PHCS Commercial |
$13,641.46
|
| Rate for Payer: United Healthcare All Payer |
$12,504.67
|
|
|
FOOT & ANKLE KIT 3CC END 11G
|
Facility
|
OP
|
$14,209.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.28 |
| Max. Negotiated Rate |
$13,641.46 |
| Rate for Payer: Aetna Commercial |
$10,941.58
|
| Rate for Payer: Anthem Medicaid |
$4,886.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,083.68
|
| Rate for Payer: Cash Price |
$7,104.92
|
| Rate for Payer: Cigna Commercial |
$11,794.18
|
| Rate for Payer: First Health Commercial |
$13,499.36
|
| Rate for Payer: Humana Commercial |
$12,078.37
|
| Rate for Payer: Humana KY Medicaid |
$4,886.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,936.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,652.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,486.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,984.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,504.67
|
| Rate for Payer: Ohio Health Group HMO |
$10,657.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,405.05
|
| Rate for Payer: PHCS Commercial |
$13,641.46
|
| Rate for Payer: United Healthcare All Payer |
$12,504.67
|
|
|
FOOT & ANKLE KIT 3CC END 15G
|
Facility
|
IP
|
$14,209.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.28 |
| Max. Negotiated Rate |
$13,641.46 |
| Rate for Payer: Aetna Commercial |
$10,941.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,083.68
|
| Rate for Payer: Cash Price |
$7,104.92
|
| Rate for Payer: Cigna Commercial |
$11,794.18
|
| Rate for Payer: First Health Commercial |
$13,499.36
|
| Rate for Payer: Humana Commercial |
$12,078.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,652.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,486.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,504.67
|
| Rate for Payer: Ohio Health Group HMO |
$10,657.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,405.05
|
| Rate for Payer: PHCS Commercial |
$13,641.46
|
| Rate for Payer: United Healthcare All Payer |
$12,504.67
|
|
|
FOOT & ANKLE KIT 3CC END 15G
|
Facility
|
OP
|
$14,209.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.28 |
| Max. Negotiated Rate |
$13,641.46 |
| Rate for Payer: Aetna Commercial |
$10,941.58
|
| Rate for Payer: Anthem Medicaid |
$4,886.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,083.68
|
| Rate for Payer: Cash Price |
$7,104.92
|
| Rate for Payer: Cigna Commercial |
$11,794.18
|
| Rate for Payer: First Health Commercial |
$13,499.36
|
| Rate for Payer: Humana Commercial |
$12,078.37
|
| Rate for Payer: Humana KY Medicaid |
$4,886.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,936.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,652.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,486.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,984.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,504.67
|
| Rate for Payer: Ohio Health Group HMO |
$10,657.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,405.05
|
| Rate for Payer: PHCS Commercial |
$13,641.46
|
| Rate for Payer: United Healthcare All Payer |
$12,504.67
|
|
|
FOOT & ANKLE KIT 3CC SIDE 11G
|
Facility
|
IP
|
$14,209.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.28 |
| Max. Negotiated Rate |
$13,641.46 |
| Rate for Payer: Aetna Commercial |
$10,941.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,083.68
|
| Rate for Payer: Cash Price |
$7,104.92
|
| Rate for Payer: Cigna Commercial |
$11,794.18
|
| Rate for Payer: First Health Commercial |
$13,499.36
|
| Rate for Payer: Humana Commercial |
$12,078.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,652.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,486.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,504.67
|
| Rate for Payer: Ohio Health Group HMO |
$10,657.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,405.05
|
| Rate for Payer: PHCS Commercial |
$13,641.46
|
| Rate for Payer: United Healthcare All Payer |
$12,504.67
|
|
|
FOOT & ANKLE KIT 3CC SIDE 11G
|
Facility
|
OP
|
$14,209.85
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,847.28 |
| Max. Negotiated Rate |
$13,641.46 |
| Rate for Payer: Aetna Commercial |
$10,941.58
|
| Rate for Payer: Anthem Medicaid |
$4,886.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,083.68
|
| Rate for Payer: Cash Price |
$7,104.92
|
| Rate for Payer: Cigna Commercial |
$11,794.18
|
| Rate for Payer: First Health Commercial |
$13,499.36
|
| Rate for Payer: Humana Commercial |
$12,078.37
|
| Rate for Payer: Humana KY Medicaid |
$4,886.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,936.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,652.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,486.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,262.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,984.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,504.67
|
| Rate for Payer: Ohio Health Group HMO |
$10,657.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,841.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,847.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,405.05
|
| Rate for Payer: PHCS Commercial |
$13,641.46
|
| Rate for Payer: United Healthcare All Payer |
$12,504.67
|
|
|
FOOT & ANKLE KIT 5CC END 11G
|
Facility
|
OP
|
$19,775.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,570.87 |
| Max. Negotiated Rate |
$18,984.91 |
| Rate for Payer: Aetna Commercial |
$15,227.48
|
| Rate for Payer: Anthem Medicaid |
$6,800.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,425.24
|
| Rate for Payer: Cash Price |
$9,887.98
|
| Rate for Payer: Cigna Commercial |
$16,414.04
|
| Rate for Payer: First Health Commercial |
$18,787.15
|
| Rate for Payer: Humana Commercial |
$16,809.56
|
| Rate for Payer: Humana KY Medicaid |
$6,800.95
|
| Rate for Payer: Kentucky WC Medicaid |
$6,870.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,216.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,594.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,932.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,937.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,402.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,831.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,955.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,570.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,130.54
|
| Rate for Payer: PHCS Commercial |
$18,984.91
|
| Rate for Payer: United Healthcare All Payer |
$17,402.84
|
|
|
FOOT & ANKLE KIT 5CC END 11G
|
Facility
|
IP
|
$19,775.95
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,570.87 |
| Max. Negotiated Rate |
$18,984.91 |
| Rate for Payer: Aetna Commercial |
$15,227.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,425.24
|
| Rate for Payer: Cash Price |
$9,887.98
|
| Rate for Payer: Cigna Commercial |
$16,414.04
|
| Rate for Payer: First Health Commercial |
$18,787.15
|
| Rate for Payer: Humana Commercial |
$16,809.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,216.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,594.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,932.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,402.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,831.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,955.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,570.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,130.54
|
| Rate for Payer: PHCS Commercial |
$18,984.91
|
| Rate for Payer: United Healthcare All Payer |
$17,402.84
|
|
|
FOOT LT 2V
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem Medicaid |
$131.37
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Humana KY Medicaid |
$131.37
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$132.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$134.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
FOOT LT 2V
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$366.72 |
| Rate for Payer: Aetna Commercial |
$294.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$317.06
|
| Rate for Payer: First Health Commercial |
$362.90
|
| Rate for Payer: Humana Commercial |
$324.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$313.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$281.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$336.16
|
| Rate for Payer: Ohio Health Group HMO |
$286.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.42
|
| Rate for Payer: PHCS Commercial |
$366.72
|
| Rate for Payer: United Healthcare All Payer |
$336.16
|
|
|
FOOT LT 2V
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
32000109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$39.20
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$382.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cash Price |
$191.00
|
| Rate for Payer: Cigna Commercial |
$39.75
|
| Rate for Payer: Healthspan PPO |
$36.74
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$229.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$267.40
|
| Rate for Payer: UHCCP Medicaid |
$133.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
|
FOOT LT 2V(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
320P0109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$39.20
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$39.75
|
| Rate for Payer: Healthspan PPO |
$36.74
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$9.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.55
|
| Rate for Payer: Molina Healthcare Passport |
$20.15
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
|
