|
Halo Partl Fce-3AreaPP#2/3 25%
|
Professional
|
Both
|
$497.00
|
|
| Hospital Charge Code |
22200484
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$497.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$497.00
|
| Rate for Payer: Cash Price |
$248.50
|
| Rate for Payer: Multiplan PHCS |
$298.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$347.90
|
| Rate for Payer: UHCCP Medicaid |
$173.95
|
|
|
HALOPERIDOL 5MG SDV
|
Facility
|
OP
|
$63.88
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
25002122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$61.32 |
| Rate for Payer: Aetna Commercial |
$49.19
|
| Rate for Payer: Anthem Medicaid |
$21.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.83
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Cigna Commercial |
$53.02
|
| Rate for Payer: First Health Commercial |
$60.69
|
| Rate for Payer: Humana Commercial |
$54.30
|
| Rate for Payer: Humana KY Medicaid |
$21.97
|
| Rate for Payer: Kentucky WC Medicaid |
$22.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.21
|
| Rate for Payer: Ohio Health Group HMO |
$47.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.80
|
| Rate for Payer: PHCS Commercial |
$61.32
|
| Rate for Payer: United Healthcare All Payer |
$56.21
|
|
|
HALOPERIDOL 5MG SDV
|
Facility
|
IP
|
$63.88
|
|
|
Service Code
|
HCPCS J1630
|
| Hospital Charge Code |
25002122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$61.32 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.83
|
| Rate for Payer: Cash Price |
$31.94
|
| Rate for Payer: Cigna Commercial |
$53.02
|
| Rate for Payer: First Health Commercial |
$60.69
|
| Rate for Payer: Humana Commercial |
$54.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.21
|
| Rate for Payer: Ohio Health Group HMO |
$47.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.80
|
| Rate for Payer: PHCS Commercial |
$61.32
|
| Rate for Payer: United Healthcare All Payer |
$56.21
|
| Rate for Payer: Aetna Commercial |
$49.19
|
|
|
HALOPERIDOL DECANOATE INJ 50mg
|
Facility
|
IP
|
$314.48
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
636T0205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.29
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Cigna Commercial |
$261.02
|
| Rate for Payer: First Health Commercial |
$298.76
|
| Rate for Payer: Humana Commercial |
$267.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.74
|
| Rate for Payer: Ohio Health Group HMO |
$235.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.49
|
| Rate for Payer: PHCS Commercial |
$301.90
|
| Rate for Payer: United Healthcare All Payer |
$276.74
|
|
|
HALOPERIDOL DECANOATE INJ 50mg
|
Facility
|
OP
|
$314.48
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
63600205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Anthem Medicaid |
$108.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.29
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Cigna Commercial |
$261.02
|
| Rate for Payer: First Health Commercial |
$298.76
|
| Rate for Payer: Humana Commercial |
$267.31
|
| Rate for Payer: Humana KY Medicaid |
$108.15
|
| Rate for Payer: Kentucky WC Medicaid |
$109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.74
|
| Rate for Payer: Ohio Health Group HMO |
$235.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.49
|
| Rate for Payer: PHCS Commercial |
$301.90
|
| Rate for Payer: United Healthcare All Payer |
$276.74
|
|
|
HALOPERIDOL DECANOATE INJ 50mg
|
Professional
|
Both
|
$314.48
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
63600205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$314.48 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$314.48
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Healthspan PPO |
$8.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$18.85
|
| Rate for Payer: Multiplan PHCS |
$188.69
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.14
|
| Rate for Payer: UHCCP Medicaid |
$110.07
|
|
|
HALOPERIDOL DECANOATE INJ 50mg
|
Facility
|
OP
|
$314.48
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
636T0205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Anthem Medicaid |
$108.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.29
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Cigna Commercial |
$261.02
|
| Rate for Payer: First Health Commercial |
$298.76
|
| Rate for Payer: Humana Commercial |
$267.31
|
| Rate for Payer: Humana KY Medicaid |
$108.15
|
| Rate for Payer: Kentucky WC Medicaid |
$109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.74
|
| Rate for Payer: Ohio Health Group HMO |
$235.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.49
|
| Rate for Payer: PHCS Commercial |
$301.90
|
| Rate for Payer: United Healthcare All Payer |
$276.74
|
|
|
HALOPERIDOL DECANOATE INJ 50mg
|
Facility
|
IP
|
$314.48
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
63600205
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$301.90 |
| Rate for Payer: Aetna Commercial |
$242.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.29
|
| Rate for Payer: Cash Price |
$157.24
|
| Rate for Payer: Cigna Commercial |
$261.02
|
| Rate for Payer: First Health Commercial |
$298.76
|
| Rate for Payer: Humana Commercial |
$267.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$257.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$276.74
|
| Rate for Payer: Ohio Health Group HMO |
$235.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.49
|
| Rate for Payer: PHCS Commercial |
$301.90
|
| Rate for Payer: United Healthcare All Payer |
$276.74
|
|
|
HA METATARSOPHALANGEAL JT
|
Facility
|
IP
|
$1,188.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.44 |
| Max. Negotiated Rate |
$1,140.48 |
| Rate for Payer: Aetna Commercial |
$914.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$926.64
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$986.04
|
| Rate for Payer: First Health Commercial |
$1,128.60
|
| Rate for Payer: Humana Commercial |
$1,009.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$876.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$356.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,045.44
|
| Rate for Payer: Ohio Health Group HMO |
$891.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.28
|
| Rate for Payer: PHCS Commercial |
$1,140.48
|
| Rate for Payer: United Healthcare All Payer |
$1,045.44
|
|
|
HA METATARSOPHALANGEAL JT
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1,188.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,188.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$712.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$831.60
|
| Rate for Payer: UHCCP Medicaid |
$415.80
|
|
|
HA METATARSOPHALANGEAL JT
|
Facility
|
OP
|
$1,188.00
|
|
|
Service Code
|
HCPCS 28899
|
| Hospital Charge Code |
76102929
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.44 |
| Max. Negotiated Rate |
$1,140.48 |
| Rate for Payer: Aetna Commercial |
$914.76
|
| Rate for Payer: Anthem Medicaid |
$408.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$926.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cash Price |
$594.00
|
| Rate for Payer: Cigna Commercial |
$986.04
|
| Rate for Payer: First Health Commercial |
$1,128.60
|
| Rate for Payer: Humana Commercial |
$1,009.80
|
| Rate for Payer: Humana KY Medicaid |
$408.55
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$412.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$974.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$876.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$416.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,045.44
|
| Rate for Payer: Ohio Health Group HMO |
$891.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$237.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$154.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$368.28
|
| Rate for Payer: PHCS Commercial |
$1,140.48
|
| Rate for Payer: United Healthcare All Payer |
$1,045.44
|
|
|
HAND 2 VIEW
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
32000087
|
|
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 |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$297.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| 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 |
$95.07
|
| 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 |
$114.08
|
| 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
|
|
|
HAND 2 VIEW
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
32000087
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$382.00 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| 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 |
$37.74
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| 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
|
|
|
HAND 2 VIEW
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
32000087
|
|
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
|
|
|
HAND 2 VIEW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
320P0087
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| 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 |
$37.74
|
| Rate for Payer: Humana Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| 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
|
|
|
HAND 2 VIEW(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
320T0087
|
|
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 |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| 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 |
$95.07
|
| 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 |
$114.08
|
| 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
|
|
|
HAND 2 VIEW(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
320T0087
|
|
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
|
|
|
HAND 3V
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
32000088
|
|
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
|
|
|
HAND 3V
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
32000088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| 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 |
$43.29
|
| 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
|
|
|
HAND 3V
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
32000088
|
|
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
|
|
|
HAND 3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
320P0088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| 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 |
$43.29
|
| 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
|
|
|
HAND 3V(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
320T0088
|
|
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
|
|
|
HAND 3V(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
320T0088
|
|
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
|
|
|
Hand/Feet LsrHrRem-PP#2/3 25%
|
Professional
|
Both
|
$63.00
|
|
| Hospital Charge Code |
22200476
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
|
|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$18,962.79
|
|
|
Service Code
|
MSDRG 513
|
| Min. Negotiated Rate |
$12,867.61 |
| Max. Negotiated Rate |
$18,962.79 |
| Rate for Payer: Anthem Medicaid |
$12,867.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13,544.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18,962.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$18,285.55
|
| Rate for Payer: Humana KY Medicaid |
$12,867.61
|
| Rate for Payer: Humana Medicare Advantage |
$13,544.85
|
| Rate for Payer: Kentucky WC Medicaid |
$12,996.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16,253.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,124.96
|
|
