|
ANESTH HYSTEROSCOPE/GRAPH
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00952
|
| Hospital Charge Code |
37000092
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH INC/MISSED AB PROC
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 01965
|
| Hospital Charge Code |
37000167
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH INC/MISSED AB PROC
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01965
|
| Hospital Charge Code |
37000167
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH INC/MISSED AB PROC
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1965
|
| Hospital Charge Code |
37000167
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH INDUCED AB PROCEDURE
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 01966
|
| Hospital Charge Code |
37000168
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH INDUCED AB PROCEDURE
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01966
|
| Hospital Charge Code |
37000168
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH INDUCED AB PROCEDURE
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1966
|
| Hospital Charge Code |
37000168
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH INSERT PENIS DEVICE
|
Professional
|
Both
|
$5.25
|
|
|
Service Code
|
HCPCS 938
|
| Hospital Charge Code |
37000270
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Multiplan PHCS |
$3.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$1.84
|
|
|
ANESTH KIDNEY STONE DESTRUCT
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00873
|
| Hospital Charge Code |
37000076
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KIDNEY STONE DESTRUCT
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 873
|
| Hospital Charge Code |
37000076
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH KIDNEY STONE DESTRUCT
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00873
|
| Hospital Charge Code |
37000076
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KIDNEY/URETER SURG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 862
|
| Hospital Charge Code |
37000072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH KIDNEY/URETER SURG
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00862
|
| Hospital Charge Code |
37000072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KIDNEY/URETER SURG
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 00862
|
| Hospital Charge Code |
37000072
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KNEE AREA PROCEDURE
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01390
|
| Hospital Charge Code |
37000112
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KNEE AREA PROCEDURE
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 01390
|
| Hospital Charge Code |
37000112
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KNEE AREA PROCEDURE
|
Professional
|
Both
|
$5.25
|
|
|
Service Code
|
HCPCS 1340
|
| Hospital Charge Code |
37000271
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Multiplan PHCS |
$3.15
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$1.84
|
|
|
ANESTH KNEE AREA PROCEDURE
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1390
|
| Hospital Charge Code |
37000112
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH KNEE AREA SURGERY
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01360
|
| Hospital Charge Code |
37000109
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KNEE AREA SURGERY
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1320
|
| Hospital Charge Code |
37000108
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH KNEE AREA SURGERY
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1392
|
| Hospital Charge Code |
37000113
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH KNEE AREA SURGERY
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01320
|
| Hospital Charge Code |
37000108
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KNEE AREA SURGERY
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 01360
|
| Hospital Charge Code |
37000109
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANESTH KNEE AREA SURGERY
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 1360
|
| Hospital Charge Code |
37000109
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANESTH KNEE AREA SURGERY
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 01392
|
| Hospital Charge Code |
37000113
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
