|
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 |
$40.28 |
| Rate for Payer: Aetna Commercial |
$40.28
|
| Rate for Payer: Ambetter Exchange |
$28.24
|
| Rate for Payer: Anthem Medicaid |
$20.15
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$28.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.24
|
| 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 |
$36.71
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.24
|
|
|
HAND 2 VIEW(T
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
320T0087
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
HAND 2 VIEW(T
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
HCPCS 73120
|
| Hospital Charge Code |
320T0087
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$339.84 |
| Rate for Payer: Aetna Commercial |
$272.58
|
| Rate for Payer: Anthem Medicaid |
$121.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$293.82
|
| Rate for Payer: First Health Commercial |
$336.30
|
| Rate for Payer: Humana Commercial |
$300.90
|
| Rate for Payer: Humana KY Medicaid |
$121.74
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$122.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$290.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$311.52
|
| Rate for Payer: Ohio Health Group HMO |
$265.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$283.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$307.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.26
|
| Rate for Payer: PHCS Commercial |
$339.84
|
| Rate for Payer: United Healthcare All Payer |
$311.52
|
|
|
HAND 3V
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
32000088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Ambetter Exchange |
$33.57
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.28
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$33.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$22.23
|
| Rate for Payer: Molina Healthcare Passport |
$21.79
|
| Rate for Payer: Multiplan PHCS |
$280.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.64
|
| Rate for Payer: UHCCP Medicaid |
$163.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.57
|
|
|
HAND 3V
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
32000088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
HAND 3V
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
32000088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
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: Ambetter Exchange |
$33.57
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.28
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$33.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.57
|
| 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 |
$43.64
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$22.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.57
|
|
|
HAND 3V(T
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
320T0088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem Medicaid |
$147.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Humana KY Medicaid |
$147.19
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$148.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
HAND 3V(T
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 73130
|
| Hospital Charge Code |
320T0088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$410.88 |
| Rate for Payer: Aetna Commercial |
$329.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.84
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$355.24
|
| Rate for Payer: First Health Commercial |
$406.60
|
| Rate for Payer: Humana Commercial |
$363.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$376.64
|
| Rate for Payer: Ohio Health Group HMO |
$321.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$372.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$295.32
|
| Rate for Payer: PHCS Commercial |
$410.88
|
| Rate for Payer: United Healthcare All Payer |
$376.64
|
|
|
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 |
$44.10 |
| 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
|
|
|
HANDSET ISTIM COMM X
|
Facility
|
OP
|
$9,015.20
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,704.56 |
| Max. Negotiated Rate |
$8,654.59 |
| Rate for Payer: Aetna Commercial |
$6,941.70
|
| Rate for Payer: Anthem Medicaid |
$3,100.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,031.86
|
| Rate for Payer: Cash Price |
$4,507.60
|
| Rate for Payer: Cigna Commercial |
$7,482.62
|
| Rate for Payer: First Health Commercial |
$8,564.44
|
| Rate for Payer: Humana Commercial |
$7,662.92
|
| Rate for Payer: Humana KY Medicaid |
$3,100.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,131.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,392.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,653.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,704.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,162.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,933.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,761.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,212.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,843.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,220.49
|
| Rate for Payer: PHCS Commercial |
$8,654.59
|
| Rate for Payer: United Healthcare All Payer |
$7,933.38
|
|
|
HANDSET ISTIM COMM X
|
Facility
|
IP
|
$9,015.20
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,704.56 |
| Max. Negotiated Rate |
$8,654.59 |
| Rate for Payer: Aetna Commercial |
$6,941.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,031.86
|
| Rate for Payer: Cash Price |
$4,507.60
|
| Rate for Payer: Cigna Commercial |
$7,482.62
|
| Rate for Payer: First Health Commercial |
$8,564.44
|
| Rate for Payer: Humana Commercial |
$7,662.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,392.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,653.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,704.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,933.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,761.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,212.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,843.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,220.49
|
| Rate for Payer: PHCS Commercial |
$8,654.59
|
| Rate for Payer: United Healthcare All Payer |
$7,933.38
|
|
|
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 |
$90.30 |
| 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 |
$70.00 |
| 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
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
30000357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.58 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$12.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.58
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| 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 |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$12.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
HAPTOGLOBIN
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 83010
|
| Hospital Charge Code |
30000357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$159.80
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
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: Ambetter Exchange |
$321.68
|
| Rate for Payer: Anthem Medicaid |
$278.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$321.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$321.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.68
|
| 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 |
$418.18
|
| Rate for Payer: UHCCP Medicaid |
$194.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$321.68
|
|
|
HARVEST FEMOROPOPLITEAL VEIN
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
HCPCS 35572
|
| Hospital Charge Code |
76101402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.50 |
| 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 |
$444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.95
|
| 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 |
$166.50 |
| 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 |
$444.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.95
|
| 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: Ambetter Exchange |
$321.68
|
| Rate for Payer: Anthem Medicaid |
$278.71
|
| Rate for Payer: Buckeye Individual/Medicaid |
$321.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$321.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$386.02
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$321.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.68
|
| 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 |
$418.18
|
| Rate for Payer: UHCCP Medicaid |
$194.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$321.68
|
|
|
HARVEST UPPER EXTREMITY OPEN
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
76101406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
HARVEST UPPER EXTREMITY OPEN
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
76101406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$174.29 |
| Max. Negotiated Rate |
$458.96 |
| Rate for Payer: Aetna Commercial |
$458.96
|
| Rate for Payer: Ambetter Exchange |
$174.29
|
| Rate for Payer: Anthem Medicaid |
$207.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$174.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.29
|
| 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 |
$226.58
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.29
|
|
|
HARVEST UPPER EXTREMITY OPEN
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 35600
|
| Hospital Charge Code |
76101406
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$150.00 |
| 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 |
$400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.00
|
| 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 |
$174.29 |
| Max. Negotiated Rate |
$458.96 |
| Rate for Payer: Aetna Commercial |
$458.96
|
| Rate for Payer: Ambetter Exchange |
$174.29
|
| Rate for Payer: Anthem Medicaid |
$207.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$174.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$174.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$209.15
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$174.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.29
|
| 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 |
$226.58
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$209.13
|
| Rate for Payer: Wellcare Medicare Advantage |
$174.29
|
|
|
HAVRIX 720 EL U/0.5 ML VIAL
|
Facility
|
OP
|
$194.38
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
25000012
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$186.60 |
| Rate for Payer: Aetna Commercial |
$149.67
|
| Rate for Payer: Anthem Medicaid |
$66.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$151.62
|
| Rate for Payer: Cash Price |
$97.19
|
| Rate for Payer: Cigna Commercial |
$161.34
|
| Rate for Payer: First Health Commercial |
$184.66
|
| Rate for Payer: Humana Commercial |
$165.22
|
| Rate for Payer: Humana KY Medicaid |
$66.85
|
| Rate for Payer: Kentucky WC Medicaid |
$67.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$159.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$143.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$58.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$68.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$171.05
|
| Rate for Payer: Ohio Health Group HMO |
$145.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$134.12
|
| Rate for Payer: PHCS Commercial |
$186.60
|
| Rate for Payer: United Healthcare All Payer |
$171.05
|
|
