|
HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,183.68
|
|
|
Service Code
|
MSDRG 514
|
| Min. Negotiated Rate |
$8,267.50 |
| Max. Negotiated Rate |
$12,183.68 |
| Rate for Payer: Anthem Medicaid |
$8,267.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$8,702.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,183.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$11,748.55
|
| Rate for Payer: Humana KY Medicaid |
$8,267.50
|
| Rate for Payer: Humana Medicare Advantage |
$8,702.63
|
| Rate for Payer: Kentucky WC Medicaid |
$8,350.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,443.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,432.85
|
|
|
HAND PROCEDURES FOR INJURIES
|
Facility
|
IP
|
$22,011.36
|
|
|
Service Code
|
MSDRG 906
|
| Min. Negotiated Rate |
$14,936.28 |
| Max. Negotiated Rate |
$22,011.36 |
| Rate for Payer: Anthem Medicaid |
$14,936.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15,722.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$22,011.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$21,225.24
|
| Rate for Payer: Humana KY Medicaid |
$14,936.28
|
| Rate for Payer: Humana Medicare Advantage |
$15,722.40
|
| Rate for Payer: Kentucky WC Medicaid |
$15,085.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18,866.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,235.01
|
|
|
HANDSET ISTIM COMM X
|
Facility
|
IP
|
$9,917.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
HANDSET ISTIM COMM X
|
Facility
|
OP
|
$9,917.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,289.28 |
| Max. Negotiated Rate |
$9,520.80 |
| Rate for Payer: Aetna Commercial |
$7,636.48
|
| Rate for Payer: Anthem Medicaid |
$3,410.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.65
|
| Rate for Payer: Cash Price |
$4,958.75
|
| Rate for Payer: Cigna Commercial |
$8,231.52
|
| Rate for Payer: First Health Commercial |
$9,421.62
|
| Rate for Payer: Humana Commercial |
$8,429.88
|
| Rate for Payer: Humana KY Medicaid |
$3,410.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,132.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,319.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,727.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,438.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,983.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,074.42
|
| Rate for Payer: PHCS Commercial |
$9,520.80
|
| Rate for Payer: United Healthcare All Payer |
$8,727.40
|
|
|
Hands/Feet LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$129.00
|
|
| Hospital Charge Code |
22200221
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$129.00
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
Hands or Feet Lsr Hair Removal
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200220
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
HAPTOGLOBIN
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
30000357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.28
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
HAPTOGLOBIN
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
30000357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$180.48 |
| Rate for Payer: Aetna Commercial |
$144.76
|
| Rate for Payer: Anthem Medicaid |
$12.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.58
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cash Price |
$94.00
|
| Rate for Payer: Cigna Commercial |
$156.04
|
| Rate for Payer: First Health Commercial |
$178.60
|
| Rate for Payer: Humana Commercial |
$159.80
|
| Rate for Payer: Humana KY Medicaid |
$12.58
|
| Rate for Payer: Humana Medicare Advantage |
$12.58
|
| Rate for Payer: Kentucky WC Medicaid |
$12.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$138.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$165.44
|
| Rate for Payer: Ohio Health Group HMO |
$141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.28
|
| Rate for Payer: PHCS Commercial |
$180.48
|
| Rate for Payer: United Healthcare All Payer |
$165.44
|
|
|
HARVEST FEMOROPOPLITEAL VEIN
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 35572
|
| Hospital Charge Code |
76101402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$623.88 |
| Rate for Payer: Aetna Commercial |
$623.88
|
| Rate for Payer: Anthem Medicaid |
$278.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$582.59
|
| Rate for Payer: Healthspan PPO |
$613.39
|
| Rate for Payer: Humana Medicaid |
$278.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$475.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.28
|
| Rate for Payer: Molina Healthcare Passport |
$278.71
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.50
|
| Rate for Payer: UHCCP Medicaid |
$194.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.50
|
|
|
HARVEST FEMOROPOPLITEAL VEIN
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS 35572
|
| Hospital Charge Code |
76101402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$427.35
|
| Rate for Payer: Anthem Medicaid |
$190.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.90
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$460.65
|
| Rate for Payer: First Health Commercial |
$527.25
|
| Rate for Payer: Humana Commercial |
$471.75
|
| Rate for Payer: Humana KY Medicaid |
$190.86
|
| Rate for Payer: Kentucky WC Medicaid |
$192.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$194.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.40
|
| Rate for Payer: Ohio Health Group HMO |
$416.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.05
|
| Rate for Payer: PHCS Commercial |
$532.80
|
| Rate for Payer: United Healthcare All Payer |
$488.40
|
|
|
HARVEST FEMOROPOPLITEAL VEIN
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
HCPCS 35572
|
| Hospital Charge Code |
76101402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.15 |
| Max. Negotiated Rate |
$532.80 |
| Rate for Payer: Aetna Commercial |
$427.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$432.90
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$460.65
|
| Rate for Payer: First Health Commercial |
$527.25
|
| Rate for Payer: Humana Commercial |
$471.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$455.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$409.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$166.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$488.40
|
| Rate for Payer: Ohio Health Group HMO |
$416.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.05
|
| Rate for Payer: PHCS Commercial |
$532.80
|
| Rate for Payer: United Healthcare All Payer |
$488.40
|
|
|
HARVEST FEMOROPOPLITEAL VEI(P
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 35572
|
| Hospital Charge Code |
761P1402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$194.25 |
| Max. Negotiated Rate |
$623.88 |
| Rate for Payer: Aetna Commercial |
$623.88
|
| Rate for Payer: Anthem Medicaid |
$278.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$555.00
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$582.59
|
| Rate for Payer: Healthspan PPO |
$613.39
|
| Rate for Payer: Humana Medicaid |
$278.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$475.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.28
|
| Rate for Payer: Molina Healthcare Passport |
$278.71
|
| Rate for Payer: Multiplan PHCS |
$333.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.50
|
| Rate for Payer: UHCCP Medicaid |
$194.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.50
|
|
|
HARVEST UPPER EXTREMITY OPEN
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
76101406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$458.96
|
| Rate for Payer: Anthem Medicaid |
$207.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$425.80
|
| Rate for Payer: Healthspan PPO |
$451.25
|
| Rate for Payer: Humana Medicaid |
$207.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.20
|
| Rate for Payer: Molina Healthcare Passport |
$207.06
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.13
|
|
|
HARVEST UPPER EXTREMITY OPEN
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
76101406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
HARVEST UPPER EXTREMITY OPEN
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
76101406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
HARVEST UPPER EXTREMITY OPEN(P
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
761P1406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$458.96
|
| Rate for Payer: Anthem Medicaid |
$207.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$425.80
|
| Rate for Payer: Healthspan PPO |
$451.25
|
| Rate for Payer: Humana Medicaid |
$207.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$350.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$211.20
|
| Rate for Payer: Molina Healthcare Passport |
$207.06
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.13
|
|
|
HAVRIX 720 EL U/0.5 ML VIAL
|
Facility
|
OP
|
$193.26
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
25000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$148.81
|
| Rate for Payer: Anthem Medicaid |
$66.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.74
|
| Rate for Payer: Cash Price |
$96.63
|
| Rate for Payer: Cigna Commercial |
$160.41
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: Humana Commercial |
$164.27
|
| Rate for Payer: Humana KY Medicaid |
$66.46
|
| Rate for Payer: Kentucky WC Medicaid |
$67.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$158.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.07
|
| Rate for Payer: Ohio Health Group HMO |
$144.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.91
|
| Rate for Payer: PHCS Commercial |
$185.53
|
| Rate for Payer: United Healthcare All Payer |
$170.07
|
|
|
HAVRIX 720 EL U/0.5 ML VIAL
|
Facility
|
IP
|
$193.26
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
25000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$185.53 |
| Rate for Payer: Aetna Commercial |
$148.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$150.74
|
| Rate for Payer: Cash Price |
$96.63
|
| Rate for Payer: Cigna Commercial |
$160.41
|
| Rate for Payer: First Health Commercial |
$183.60
|
| Rate for Payer: Humana Commercial |
$164.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$158.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$142.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$170.07
|
| Rate for Payer: Ohio Health Group HMO |
$144.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.91
|
| Rate for Payer: PHCS Commercial |
$185.53
|
| Rate for Payer: United Healthcare All Payer |
$170.07
|
|
|
HAWK 1 7FR STD. NOSECONE
|
Facility
|
IP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
HAWK 1 7FR STD. NOSECONE
|
Facility
|
OP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem Medicaid |
$5,406.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Humana KY Medicaid |
$5,406.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,461.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
HAWK 1 LONG NOSECONE
|
Facility
|
OP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem Medicaid |
$5,406.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Humana KY Medicaid |
$5,406.11
|
| Rate for Payer: Kentucky WC Medicaid |
$5,461.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
HAWK 1 LONG NOSECONE
|
Facility
|
IP
|
$15,720.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,043.60 |
| Max. Negotiated Rate |
$15,091.20 |
| Rate for Payer: Aetna Commercial |
$12,104.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,261.60
|
| Rate for Payer: Cash Price |
$7,860.00
|
| Rate for Payer: Cigna Commercial |
$13,047.60
|
| Rate for Payer: First Health Commercial |
$14,934.00
|
| Rate for Payer: Humana Commercial |
$13,362.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,890.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,601.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,716.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,833.60
|
| Rate for Payer: Ohio Health Group HMO |
$11,790.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,043.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,873.20
|
| Rate for Payer: PHCS Commercial |
$15,091.20
|
| Rate for Payer: United Healthcare All Payer |
$13,833.60
|
|
|
HAWKONE V01
|
Facility
|
OP
|
$28,525.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,708.25 |
| Max. Negotiated Rate |
$27,384.00 |
| Rate for Payer: Aetna Commercial |
$21,964.25
|
| Rate for Payer: Anthem Medicaid |
$9,809.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,249.50
|
| Rate for Payer: Cash Price |
$14,262.50
|
| Rate for Payer: Cigna Commercial |
$23,675.75
|
| Rate for Payer: First Health Commercial |
$27,098.75
|
| Rate for Payer: Humana Commercial |
$24,246.25
|
| Rate for Payer: Humana KY Medicaid |
$9,809.75
|
| Rate for Payer: Kentucky WC Medicaid |
$9,909.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,390.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,051.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,557.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,006.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,102.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,705.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,708.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,842.75
|
| Rate for Payer: PHCS Commercial |
$27,384.00
|
| Rate for Payer: United Healthcare All Payer |
$25,102.00
|
|
|
HAWKONE V01
|
Facility
|
IP
|
$28,525.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,708.25 |
| Max. Negotiated Rate |
$27,384.00 |
| Rate for Payer: Aetna Commercial |
$21,964.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,249.50
|
| Rate for Payer: Cash Price |
$14,262.50
|
| Rate for Payer: Cigna Commercial |
$23,675.75
|
| Rate for Payer: First Health Commercial |
$27,098.75
|
| Rate for Payer: Humana Commercial |
$24,246.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,390.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,051.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,557.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,102.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,705.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,708.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,842.75
|
| Rate for Payer: PHCS Commercial |
$27,384.00
|
| Rate for Payer: United Healthcare All Payer |
$25,102.00
|
|
|
HAWKONE V02
|
Facility
|
OP
|
$28,525.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
27000007
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,708.25 |
| Max. Negotiated Rate |
$27,384.00 |
| Rate for Payer: Aetna Commercial |
$21,964.25
|
| Rate for Payer: Anthem Medicaid |
$9,809.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,249.50
|
| Rate for Payer: Cash Price |
$14,262.50
|
| Rate for Payer: Cigna Commercial |
$23,675.75
|
| Rate for Payer: First Health Commercial |
$27,098.75
|
| Rate for Payer: Humana Commercial |
$24,246.25
|
| Rate for Payer: Humana KY Medicaid |
$9,809.75
|
| Rate for Payer: Kentucky WC Medicaid |
$9,909.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,390.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,051.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,557.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,006.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,102.00
|
| Rate for Payer: Ohio Health Group HMO |
$21,393.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,705.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,708.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,842.75
|
| Rate for Payer: PHCS Commercial |
$27,384.00
|
| Rate for Payer: United Healthcare All Payer |
$25,102.00
|
|
