|
INIT NB EM PER DAY HOSP
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
51000117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$89.31
|
| Rate for Payer: Ambetter Exchange |
$86.78
|
| Rate for Payer: Anthem Medicaid |
$45.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.14
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$90.67
|
| Rate for Payer: Healthspan PPO |
$66.39
|
| Rate for Payer: Humana Medicaid |
$45.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.91
|
| Rate for Payer: Molina Healthcare Passport |
$45.99
|
| Rate for Payer: Multiplan PHCS |
$182.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.81
|
| Rate for Payer: UHCCP Medicaid |
$106.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.78
|
|
|
INIT NB EM PER DAY HOSP(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
510P0117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$112.81 |
| Rate for Payer: Aetna Commercial |
$89.31
|
| Rate for Payer: Ambetter Exchange |
$86.78
|
| Rate for Payer: Anthem Medicaid |
$45.99
|
| Rate for Payer: Buckeye Individual/Medicaid |
$86.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$86.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.14
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$90.67
|
| Rate for Payer: Healthspan PPO |
$66.39
|
| Rate for Payer: Humana Medicaid |
$45.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$78.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$86.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$46.91
|
| Rate for Payer: Molina Healthcare Passport |
$45.99
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$112.81
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$46.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$86.78
|
|
|
INIT NB EM PER DAY HOSP(T
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
510T0117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$61.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$61.56
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$62.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
INIT NB EM PER DAY HOSP(T
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 99460
|
| Hospital Charge Code |
510T0117
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$139.62
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
INIT PM E/M NEW PAT INFANT
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
INIT PM E/M NEW PAT INFANT
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$211.20 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Anthem Medicaid |
$75.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$171.60
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$182.60
|
| Rate for Payer: First Health Commercial |
$209.00
|
| Rate for Payer: Humana Commercial |
$187.00
|
| Rate for Payer: Humana KY Medicaid |
$75.66
|
| Rate for Payer: Kentucky WC Medicaid |
$76.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$180.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$162.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$193.60
|
| Rate for Payer: Ohio Health Group HMO |
$165.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$176.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$191.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$151.80
|
| Rate for Payer: PHCS Commercial |
$211.20
|
| Rate for Payer: United Healthcare All Payer |
$193.60
|
|
|
INIT PM E/M NEW PAT INFANT
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
51000096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$78.58
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$141.55
|
| Rate for Payer: Healthspan PPO |
$106.16
|
| Rate for Payer: Humana Medicaid |
$78.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.15
|
| Rate for Payer: Molina Healthcare Passport |
$78.58
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.37
|
|
|
INIT PM E/M NEW PAT INFANT(P
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99381
|
| Hospital Charge Code |
510P0096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$38.57
|
| Rate for Payer: Anthem Medicaid |
$78.58
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cigna Commercial |
$141.55
|
| Rate for Payer: Healthspan PPO |
$106.16
|
| Rate for Payer: Humana Medicaid |
$78.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$79.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.15
|
| Rate for Payer: Molina Healthcare Passport |
$78.58
|
| Rate for Payer: Multiplan PHCS |
$132.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$154.00
|
| Rate for Payer: UHCCP Medicaid |
$40.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.37
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.60
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna Commercial |
$69.92
|
| Rate for Payer: Ambetter Exchange |
$43.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.35
|
| Rate for Payer: Anthem Medicaid |
$36.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.22
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$97.53
|
| Rate for Payer: Healthspan PPO |
$77.73
|
| Rate for Payer: Humana Medicaid |
$36.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.95
|
| Rate for Payer: Molina Healthcare Passport |
$36.23
|
| Rate for Payer: Multiplan PHCS |
$222.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.58
|
| Rate for Payer: UHCCP Medicaid |
$25.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.52
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
76100242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.24 |
| Max. Negotiated Rate |
$355.20 |
| Rate for Payer: Aetna Commercial |
$284.90
|
| Rate for Payer: Anthem Medicaid |
$127.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$288.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cash Price |
$185.00
|
| Rate for Payer: Cigna Commercial |
$307.10
|
| Rate for Payer: First Health Commercial |
$351.50
|
| Rate for Payer: Humana Commercial |
$314.50
|
| Rate for Payer: Humana KY Medicaid |
$127.24
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$128.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$303.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$325.60
|
| Rate for Payer: Ohio Health Group HMO |
$277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$321.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.30
|
| Rate for Payer: PHCS Commercial |
$355.20
|
| Rate for Payer: United Healthcare All Payer |
$325.60
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
INIT TX 1STDGR BURN NOOTH TX
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
45000077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.85 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem Medicaid |
$92.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Humana KY Medicaid |
$92.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$93.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
INIT TX 1STDGR BURN NOOTH TX(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
761P0242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$97.53 |
| Rate for Payer: Aetna Commercial |
$69.92
|
| Rate for Payer: Ambetter Exchange |
$43.52
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.35
|
| Rate for Payer: Anthem Medicaid |
$36.23
|
| Rate for Payer: Buckeye Individual/Medicaid |
$43.52
|
| Rate for Payer: Buckeye Medicare Advantage |
$43.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$52.22
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$97.53
|
| Rate for Payer: Healthspan PPO |
$77.73
|
| Rate for Payer: Humana Medicaid |
$36.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.84
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$43.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$36.95
|
| Rate for Payer: Molina Healthcare Passport |
$36.23
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.58
|
| Rate for Payer: UHCCP Medicaid |
$25.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$43.52
|
|
|
INIT TX 1STDGR BURN NOOTH TX(T
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
761T0242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
INIT TX 1STDGR BURN NOOTH TX(T
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS 16000
|
| Hospital Charge Code |
761T0242
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$92.85 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Anthem Medicaid |
$92.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$183.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$210.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$257.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$247.85
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$224.10
|
| Rate for Payer: First Health Commercial |
$256.50
|
| Rate for Payer: Humana Commercial |
$229.50
|
| Rate for Payer: Humana KY Medicaid |
$92.85
|
| Rate for Payer: Humana Medicare Advantage |
$183.59
|
| Rate for Payer: Kentucky WC Medicaid |
$93.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$221.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$199.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$237.60
|
| Rate for Payer: Ohio Health Group HMO |
$202.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$186.30
|
| Rate for Payer: PHCS Commercial |
$259.20
|
| Rate for Payer: United Healthcare All Payer |
$237.60
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76102847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem Medicaid |
$167.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Humana KY Medicaid |
$167.48
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$169.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$170.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.03
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76102847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$292.20 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Ambetter Exchange |
$37.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$53.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$53.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.01
|
| Rate for Payer: Molina Healthcare Passport |
$53.93
|
| Rate for Payer: Multiplan PHCS |
$292.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.14
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.03
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$152.70 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$175.05 |
| Max. Negotiated Rate |
$488.64 |
| Rate for Payer: Aetna Commercial |
$391.93
|
| Rate for Payer: Anthem Medicaid |
$175.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$397.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$422.47
|
| Rate for Payer: First Health Commercial |
$483.55
|
| Rate for Payer: Humana Commercial |
$432.65
|
| Rate for Payer: Humana KY Medicaid |
$175.05
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$176.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$417.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$375.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.92
|
| Rate for Payer: Ohio Health Group HMO |
$381.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.21
|
| Rate for Payer: PHCS Commercial |
$488.64
|
| Rate for Payer: United Healthcare All Payer |
$447.92
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76100337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$305.40 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Ambetter Exchange |
$37.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$53.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cash Price |
$254.50
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$53.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.01
|
| Rate for Payer: Molina Healthcare Passport |
$53.93
|
| Rate for Payer: Multiplan PHCS |
$305.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.14
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.03
|
|
|
INJ 1 TENDON SHEATH LIGAMENT
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
76102847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$146.10 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$374.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$379.86
|
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Cigna Commercial |
$404.21
|
| Rate for Payer: First Health Commercial |
$462.65
|
| Rate for Payer: Humana Commercial |
$413.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$399.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$359.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$146.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$428.56
|
| Rate for Payer: Ohio Health Group HMO |
$365.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.03
|
| Rate for Payer: PHCS Commercial |
$467.52
|
| Rate for Payer: United Healthcare All Payer |
$428.56
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(P
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761P2847
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$93.49 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Ambetter Exchange |
$37.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$53.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$53.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.01
|
| Rate for Payer: Molina Healthcare Passport |
$53.93
|
| Rate for Payer: Multiplan PHCS |
$82.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.14
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.03
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(P
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761P0337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$93.49 |
| Rate for Payer: Aetna Commercial |
$64.16
|
| Rate for Payer: Ambetter Exchange |
$37.03
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.70
|
| Rate for Payer: Anthem Medicaid |
$53.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$93.49
|
| Rate for Payer: Healthspan PPO |
$76.53
|
| Rate for Payer: Humana Medicaid |
$53.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$51.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$55.01
|
| Rate for Payer: Molina Healthcare Passport |
$53.93
|
| Rate for Payer: Multiplan PHCS |
$82.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.14
|
| Rate for Payer: UHCCP Medicaid |
$34.34
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$54.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.03
|
|
|
INJ 1 TENDON SHEATH LIGAMENT(T
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
761T0337
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$381.85 |
| Rate for Payer: Aetna Commercial |
$285.67
|
| Rate for Payer: Anthem Medicaid |
$127.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$289.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cash Price |
$185.50
|
| Rate for Payer: Cigna Commercial |
$307.93
|
| Rate for Payer: First Health Commercial |
$352.45
|
| Rate for Payer: Humana Commercial |
$315.35
|
| Rate for Payer: Humana KY Medicaid |
$127.59
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$128.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$304.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$273.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$326.48
|
| Rate for Payer: Ohio Health Group HMO |
$278.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$296.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$255.99
|
| Rate for Payer: PHCS Commercial |
$356.16
|
| Rate for Payer: United Healthcare All Payer |
$326.48
|
|
