|
FOOT LT 2V(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
320T0109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
FOOT LT 2V(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73620
|
| Hospital Charge Code |
320T0109
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
FOOT LT MIN OF 3V
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$442.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$42.80
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$265.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$309.40
|
| Rate for Payer: UHCCP Medicaid |
$154.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
|
|
FOOT LT MIN OF 3V
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.02
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
FOOT LT MIN OF 3V
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
32000110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$424.32 |
| Rate for Payer: Aetna Commercial |
$340.34
|
| Rate for Payer: Anthem Medicaid |
$152.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$344.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cash Price |
$221.00
|
| Rate for Payer: Cigna Commercial |
$366.86
|
| Rate for Payer: First Health Commercial |
$419.90
|
| Rate for Payer: Humana Commercial |
$375.70
|
| Rate for Payer: Humana KY Medicaid |
$152.00
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$153.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$388.96
|
| Rate for Payer: Ohio Health Group HMO |
$331.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.02
|
| Rate for Payer: PHCS Commercial |
$424.32
|
| Rate for Payer: United Healthcare All Payer |
$388.96
|
|
|
FOOT LT MIN OF 3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
320P0110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$45.67 |
| Rate for Payer: Aetna Commercial |
$45.67
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$43.65
|
| Rate for Payer: Healthspan PPO |
$42.80
|
| Rate for Payer: Humana Medicaid |
$21.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
|
|
FOOT LT MIN OF 3V(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
320T0110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
FOOT LT MIN OF 3V(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 73630
|
| Hospital Charge Code |
320T0110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.26 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.62
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
FOOT PROCEDURES WITH CC
|
Facility
|
IP
|
$20,203.96
|
|
|
Service Code
|
MSDRG 504
|
| Min. Negotiated Rate |
$13,709.83 |
| Max. Negotiated Rate |
$20,203.96 |
| Rate for Payer: Anthem Medicaid |
$13,709.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,431.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,203.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,482.39
|
| Rate for Payer: Humana KY Medicaid |
$13,709.83
|
| Rate for Payer: Humana Medicare Advantage |
$14,431.40
|
| Rate for Payer: Kentucky WC Medicaid |
$13,846.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,317.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,984.03
|
|
|
FOOT PROCEDURES WITH MCC
|
Facility
|
IP
|
$31,373.41
|
|
|
Service Code
|
MSDRG 503
|
| Min. Negotiated Rate |
$21,289.10 |
| Max. Negotiated Rate |
$31,373.41 |
| Rate for Payer: Anthem Medicaid |
$21,289.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22,409.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31,373.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$30,252.93
|
| Rate for Payer: Humana KY Medicaid |
$21,289.10
|
| Rate for Payer: Humana Medicare Advantage |
$22,409.58
|
| Rate for Payer: Kentucky WC Medicaid |
$21,501.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,891.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,714.88
|
|
|
FOOT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,953.64
|
|
|
Service Code
|
MSDRG 505
|
| Min. Negotiated Rate |
$13,539.97 |
| Max. Negotiated Rate |
$19,953.64 |
| Rate for Payer: Anthem Medicaid |
$13,539.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14,252.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$19,953.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$19,241.01
|
| Rate for Payer: Humana KY Medicaid |
$13,539.97
|
| Rate for Payer: Humana Medicare Advantage |
$14,252.60
|
| Rate for Payer: Kentucky WC Medicaid |
$13,675.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17,103.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,810.77
|
|
|
FOOT RING PLATE 210MM
|
Facility
|
OP
|
$7,206.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.78 |
| Max. Negotiated Rate |
$6,917.78 |
| Rate for Payer: Aetna Commercial |
$5,548.64
|
| Rate for Payer: Anthem Medicaid |
$2,478.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.70
|
| Rate for Payer: Cash Price |
$3,603.01
|
| Rate for Payer: Cigna Commercial |
$5,981.00
|
| Rate for Payer: First Health Commercial |
$6,845.72
|
| Rate for Payer: Humana Commercial |
$6,125.12
|
| Rate for Payer: Humana KY Medicaid |
$2,478.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,503.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,908.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,318.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,341.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.87
|
| Rate for Payer: PHCS Commercial |
$6,917.78
|
| Rate for Payer: United Healthcare All Payer |
$6,341.30
|
|
|
FOOT RING PLATE 210MM
|
Facility
|
IP
|
$7,206.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.78 |
| Max. Negotiated Rate |
$6,917.78 |
| Rate for Payer: Aetna Commercial |
$5,548.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.70
|
| Rate for Payer: Cash Price |
$3,603.01
|
| Rate for Payer: Cigna Commercial |
$5,981.00
|
| Rate for Payer: First Health Commercial |
$6,845.72
|
| Rate for Payer: Humana Commercial |
$6,125.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,908.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,318.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,341.30
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,233.87
|
| Rate for Payer: PHCS Commercial |
$6,917.78
|
| Rate for Payer: United Healthcare All Payer |
$6,341.30
|
|
|
FOOT/TOES SURGERY PROCEDURE
|
Facility
|
OP
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76101045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$3,980.19 |
| Rate for Payer: Aetna Commercial |
$3,192.44
|
| Rate for Payer: Anthem Medicaid |
$1,425.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cigna Commercial |
$3,441.20
|
| Rate for Payer: First Health Commercial |
$3,938.73
|
| Rate for Payer: Humana Commercial |
$3,524.13
|
| Rate for Payer: Humana KY Medicaid |
$1,425.82
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,440.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.27
|
| Rate for Payer: PHCS Commercial |
$3,980.19
|
| Rate for Payer: United Healthcare All Payer |
$3,648.51
|
|
|
FOOT/TOES SURGERY PROCEDURE
|
Facility
|
IP
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76101045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.98 |
| Max. Negotiated Rate |
$3,980.19 |
| Rate for Payer: Aetna Commercial |
$3,192.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.90
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cigna Commercial |
$3,441.20
|
| Rate for Payer: First Health Commercial |
$3,938.73
|
| Rate for Payer: Humana Commercial |
$3,524.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.27
|
| Rate for Payer: PHCS Commercial |
$3,980.19
|
| Rate for Payer: United Healthcare All Payer |
$3,648.51
|
|
|
FOOT/TOES SURGERY PROCEDURE
|
Professional
|
Both
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76101045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4,146.03 |
| Rate for Payer: Buckeye Medicare Advantage |
$4,146.03
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$2,487.62
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,902.22
|
| Rate for Payer: UHCCP Medicaid |
$1,451.11
|
|
|
FOOT/TOES SURGERY PROCEDURE(T
|
Facility
|
OP
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
761T1045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$3,980.19 |
| Rate for Payer: Aetna Commercial |
$3,192.44
|
| Rate for Payer: Anthem Medicaid |
$1,425.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cigna Commercial |
$3,441.20
|
| Rate for Payer: First Health Commercial |
$3,938.73
|
| Rate for Payer: Humana Commercial |
$3,524.13
|
| Rate for Payer: Humana KY Medicaid |
$1,425.82
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,440.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.27
|
| Rate for Payer: PHCS Commercial |
$3,980.19
|
| Rate for Payer: United Healthcare All Payer |
$3,648.51
|
|
|
FOOT/TOES SURGERY PROCEDURE(T
|
Facility
|
IP
|
$4,146.03
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
761T1045
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$538.98 |
| Max. Negotiated Rate |
$3,980.19 |
| Rate for Payer: Aetna Commercial |
$3,192.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.90
|
| Rate for Payer: Cash Price |
$2,073.01
|
| Rate for Payer: Cigna Commercial |
$3,441.20
|
| Rate for Payer: First Health Commercial |
$3,938.73
|
| Rate for Payer: Humana Commercial |
$3,524.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,648.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,109.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.27
|
| Rate for Payer: PHCS Commercial |
$3,980.19
|
| Rate for Payer: United Healthcare All Payer |
$3,648.51
|
|
|
FOREFOOT IB IMPLANT SYSTEM PE
|
Facility
|
OP
|
$7,891.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.93 |
| Max. Negotiated Rate |
$7,576.08 |
| Rate for Payer: Aetna Commercial |
$6,076.65
|
| Rate for Payer: Anthem Medicaid |
$2,713.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.56
|
| Rate for Payer: Cash Price |
$3,945.88
|
| Rate for Payer: Cigna Commercial |
$6,550.15
|
| Rate for Payer: First Health Commercial |
$7,497.16
|
| Rate for Payer: Humana Commercial |
$6,707.99
|
| Rate for Payer: Humana KY Medicaid |
$2,713.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,824.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,025.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.44
|
| Rate for Payer: PHCS Commercial |
$7,576.08
|
| Rate for Payer: United Healthcare All Payer |
$6,944.74
|
|
|
FOREFOOT IB IMPLANT SYSTEM PE
|
Facility
|
IP
|
$7,891.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,025.93 |
| Max. Negotiated Rate |
$7,576.08 |
| Rate for Payer: Aetna Commercial |
$6,076.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.56
|
| Rate for Payer: Cash Price |
$3,945.88
|
| Rate for Payer: Cigna Commercial |
$6,550.15
|
| Rate for Payer: First Health Commercial |
$7,497.16
|
| Rate for Payer: Humana Commercial |
$6,707.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,824.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,578.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,025.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,446.44
|
| Rate for Payer: PHCS Commercial |
$7,576.08
|
| Rate for Payer: United Healthcare All Payer |
$6,944.74
|
|
|
FOREIGN BODYEYE SCRNG FOR MRI
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$503.04 |
| Rate for Payer: Aetna Commercial |
$403.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$408.72
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$434.92
|
| Rate for Payer: First Health Commercial |
$497.80
|
| Rate for Payer: Humana Commercial |
$445.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$429.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$461.12
|
| Rate for Payer: Ohio Health Group HMO |
$393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.44
|
| Rate for Payer: PHCS Commercial |
$503.04
|
| Rate for Payer: United Healthcare All Payer |
$461.12
|
|
|
FOREIGN BODYEYE SCRNG FOR MRI
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$524.00
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$38.68
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.21
|
| Rate for Payer: Molina Healthcare Passport |
$18.83
|
| Rate for Payer: Multiplan PHCS |
$314.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$366.80
|
| Rate for Payer: UHCCP Medicaid |
$183.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.02
|
|
|
FOREIGN BODYEYE SCRNG FOR MRI
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
32000010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.12 |
| Max. Negotiated Rate |
$503.04 |
| Rate for Payer: Aetna Commercial |
$403.48
|
| Rate for Payer: Anthem Medicaid |
$180.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$408.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cash Price |
$262.00
|
| Rate for Payer: Cigna Commercial |
$434.92
|
| Rate for Payer: First Health Commercial |
$497.80
|
| Rate for Payer: Humana Commercial |
$445.40
|
| Rate for Payer: Humana KY Medicaid |
$180.20
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$429.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$386.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$461.12
|
| Rate for Payer: Ohio Health Group HMO |
$393.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$104.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$162.44
|
| Rate for Payer: PHCS Commercial |
$503.04
|
| Rate for Payer: United Healthcare All Payer |
$461.12
|
|
|
FOREIGN BODYEYE SCRNG FOR MR(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
320P0010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$42.45
|
| Rate for Payer: Anthem Medicaid |
$18.83
|
| 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 |
$38.68
|
| Rate for Payer: Healthspan PPO |
$39.78
|
| Rate for Payer: Humana Medicaid |
$18.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.21
|
| Rate for Payer: Molina Healthcare Passport |
$18.83
|
| 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 |
$19.02
|
|
|
FOREIGN BODYEYE SCRNG FOR MR(T
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
HCPCS 70030
|
| Hospital Charge Code |
320T0010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$455.04 |
| Rate for Payer: Aetna Commercial |
$364.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$369.72
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$393.42
|
| Rate for Payer: First Health Commercial |
$450.30
|
| Rate for Payer: Humana Commercial |
$402.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$388.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$349.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$417.12
|
| Rate for Payer: Ohio Health Group HMO |
$355.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$94.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.94
|
| Rate for Payer: PHCS Commercial |
$455.04
|
| Rate for Payer: United Healthcare All Payer |
$417.12
|
|
