|
APP CAST SHOULD> HAND LONG ARM
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
76101046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna Commercial |
$99.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.34
|
| Rate for Payer: Anthem Medicaid |
$39.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$629.00
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cash Price |
$314.50
|
| Rate for Payer: Cigna Commercial |
$143.95
|
| Rate for Payer: Healthspan PPO |
$117.70
|
| Rate for Payer: Humana Medicaid |
$39.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.21
|
| Rate for Payer: Molina Healthcare Passport |
$39.42
|
| Rate for Payer: Multiplan PHCS |
$377.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$440.30
|
| Rate for Payer: UHCCP Medicaid |
$57.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.81
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
45000183
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$46.15 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Aetna Commercial |
$273.35
|
| Rate for Payer: Anthem Medicaid |
$122.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$232.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$276.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$325.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$313.52
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cash Price |
$177.50
|
| Rate for Payer: Cigna Commercial |
$294.65
|
| Rate for Payer: First Health Commercial |
$337.25
|
| Rate for Payer: Humana Commercial |
$301.75
|
| Rate for Payer: Humana KY Medicaid |
$122.08
|
| Rate for Payer: Humana Medicare Advantage |
$232.24
|
| Rate for Payer: Kentucky WC Medicaid |
$123.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$291.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$261.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$124.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$312.40
|
| Rate for Payer: Ohio Health Group HMO |
$266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.05
|
| Rate for Payer: PHCS Commercial |
$340.80
|
| Rate for Payer: United Healthcare All Payer |
$312.40
|
|
|
APP CAST SHOULD> HAND LONG ARM
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 29065
|
| Hospital Charge Code |
761P1046
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.42 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$99.44
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.34
|
| Rate for Payer: Anthem Medicaid |
$39.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$143.95
|
| Rate for Payer: Healthspan PPO |
$117.70
|
| Rate for Payer: Humana Medicaid |
$39.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.21
|
| Rate for Payer: Molina Healthcare Passport |
$39.42
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$57.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$39.81
|
|
|
APP CLUFT CAS WMOLDIMAN LNGSHT
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
45000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
APP CLUFT CAS WMOLDIMAN LNGSHT
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
76101063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
APP CLUFT CAS WMOLDIMAN LNGSHT
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
45000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$200.64 |
| Rate for Payer: Aetna Commercial |
$160.93
|
| Rate for Payer: Anthem Medicaid |
$71.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cigna Commercial |
$173.47
|
| Rate for Payer: First Health Commercial |
$198.55
|
| Rate for Payer: Humana Commercial |
$177.65
|
| Rate for Payer: Humana KY Medicaid |
$71.88
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$72.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$171.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$183.92
|
| Rate for Payer: Ohio Health Group HMO |
$156.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.79
|
| Rate for Payer: PHCS Commercial |
$200.64
|
| Rate for Payer: United Healthcare All Payer |
$183.92
|
|
|
APP CLUFT CAS WMOLDIMAN LNGSHT
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 29450
|
| Hospital Charge Code |
76101063
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$190.76 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$136.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$183.95
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Humana Medicare Advantage |
$136.26
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$163.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$59.52
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
APPENDECTOMY
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
76101869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$927.50
|
| Rate for Payer: Anthem Medicaid |
$443.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$867.13
|
| Rate for Payer: Healthspan PPO |
$782.18
|
| Rate for Payer: Humana Medicaid |
$443.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$818.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$452.66
|
| Rate for Payer: Molina Healthcare Passport |
$443.78
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.22
|
|
|
APPENDECTOMY
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
76101869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
APPENDECTOMY
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
76101869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$9,159.29 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,542.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,159.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,832.17
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Humana Medicare Advantage |
$6,542.35
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,850.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$496.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
APPENDECTOMY; FOR RUPTURED APP
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 44960
|
| Hospital Charge Code |
76101871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.09 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$1,244.88
|
| Rate for Payer: Anthem Medicaid |
$475.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,151.91
|
| Rate for Payer: Healthspan PPO |
$1,049.83
|
| Rate for Payer: Humana Medicaid |
$475.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,113.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$484.59
|
| Rate for Payer: Molina Healthcare Passport |
$475.09
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.84
|
|
|
APPENDECTOMY; FOR RUPTURED APP
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 44960
|
| Hospital Charge Code |
76101871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem Medicaid |
$498.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Humana KY Medicaid |
$498.66
|
| Rate for Payer: Kentucky WC Medicaid |
$503.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$508.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
APPENDECTOMY; FOR RUPTURED APP
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
HCPCS 44960
|
| Hospital Charge Code |
76101871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$188.50 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$1,116.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,131.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,203.50
|
| Rate for Payer: First Health Commercial |
$1,377.50
|
| Rate for Payer: Humana Commercial |
$1,232.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,189.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,070.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$435.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,276.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$290.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$188.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$449.50
|
| Rate for Payer: PHCS Commercial |
$1,392.00
|
| Rate for Payer: United Healthcare All Payer |
$1,276.00
|
|
|
APPENDECTOMY; FOR RUPTURED APP
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 44960
|
| Hospital Charge Code |
761P1871
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$475.09 |
| Max. Negotiated Rate |
$1,450.00 |
| Rate for Payer: Aetna Commercial |
$1,244.88
|
| Rate for Payer: Anthem Medicaid |
$475.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,450.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cash Price |
$725.00
|
| Rate for Payer: Cigna Commercial |
$1,151.91
|
| Rate for Payer: Healthspan PPO |
$1,049.83
|
| Rate for Payer: Humana Medicaid |
$475.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,113.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$484.59
|
| Rate for Payer: Molina Healthcare Passport |
$475.09
|
| Rate for Payer: Multiplan PHCS |
$870.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,015.00
|
| Rate for Payer: UHCCP Medicaid |
$507.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$479.84
|
|
|
APPENDECTOMY(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
761P1869
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$443.78 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$927.50
|
| Rate for Payer: Anthem Medicaid |
$443.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$867.13
|
| Rate for Payer: Healthspan PPO |
$782.18
|
| Rate for Payer: Humana Medicaid |
$443.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$818.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$452.66
|
| Rate for Payer: Molina Healthcare Passport |
$443.78
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$448.22
|
|
|
APPENDECTOMY; WHEN DONE FOR IN
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
76101870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.26 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$127.19
|
| Rate for Payer: Anthem Medicaid |
$112.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$120.93
|
| Rate for Payer: Healthspan PPO |
$107.26
|
| Rate for Payer: Humana Medicaid |
$112.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.29
|
| Rate for Payer: Molina Healthcare Passport |
$112.05
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.17
|
|
|
APPENDECTOMY; WHEN DONE FOR IN
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
76101870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
APPENDECTOMY; WHEN DONE FOR IN
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
761P1870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$107.26 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$127.19
|
| Rate for Payer: Anthem Medicaid |
$112.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$120.93
|
| Rate for Payer: Healthspan PPO |
$107.26
|
| Rate for Payer: Humana Medicaid |
$112.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.29
|
| Rate for Payer: Molina Healthcare Passport |
$112.05
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.17
|
|
|
APPENDECTOMY; WHEN DONE FOR IN
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
76101870
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
|
IP
|
$17,702.89
|
|
|
Service Code
|
MSDRG 398
|
| Min. Negotiated Rate |
$12,012.67 |
| Max. Negotiated Rate |
$17,702.89 |
| Rate for Payer: Anthem Medicaid |
$12,012.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12,644.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$17,702.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$17,070.64
|
| Rate for Payer: Humana KY Medicaid |
$12,012.67
|
| Rate for Payer: Humana Medicare Advantage |
$12,644.92
|
| Rate for Payer: Kentucky WC Medicaid |
$12,132.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15,173.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,252.93
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
|
IP
|
$26,281.19
|
|
|
Service Code
|
MSDRG 397
|
| Min. Negotiated Rate |
$17,833.67 |
| Max. Negotiated Rate |
$26,281.19 |
| Rate for Payer: Anthem Medicaid |
$17,833.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18,772.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$26,281.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$25,342.58
|
| Rate for Payer: Humana KY Medicaid |
$17,833.67
|
| Rate for Payer: Humana Medicare Advantage |
$18,772.28
|
| Rate for Payer: Kentucky WC Medicaid |
$18,012.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22,526.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,190.34
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,021.29
|
|
|
Service Code
|
MSDRG 399
|
| Min. Negotiated Rate |
$8,835.87 |
| Max. Negotiated Rate |
$13,021.29 |
| Rate for Payer: Anthem Medicaid |
$8,835.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,300.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,021.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,556.24
|
| Rate for Payer: Humana KY Medicaid |
$8,835.87
|
| Rate for Payer: Humana Medicare Advantage |
$9,300.92
|
| Rate for Payer: Kentucky WC Medicaid |
$8,924.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,161.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,012.59
|
|
|
APPENDIX ULTRASOUND LTD
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem Medicaid |
$379.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Humana KY Medicaid |
$379.67
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$387.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
|
APPENDIX ULTRASOUND LTD
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$63.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,104.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$135.13
|
| Rate for Payer: Healthspan PPO |
$147.57
|
| Rate for Payer: Humana Medicaid |
$63.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$37.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$65.20
|
| Rate for Payer: Molina Healthcare Passport |
$63.92
|
| Rate for Payer: Multiplan PHCS |
$662.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$772.80
|
| Rate for Payer: UHCCP Medicaid |
$386.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.56
|
|
|
APPENDIX ULTRASOUND LTD
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
HCPCS 76705
|
| Hospital Charge Code |
40200016
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$143.52 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Ohio Health Choice Commercial |
$971.52
|
| Rate for Payer: Aetna Commercial |
$850.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$861.12
|
| Rate for Payer: Cash Price |
$552.00
|
| Rate for Payer: Cigna Commercial |
$916.32
|
| Rate for Payer: First Health Commercial |
$1,048.80
|
| Rate for Payer: Humana Commercial |
$938.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$905.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$814.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$331.20
|
| Rate for Payer: Ohio Health Group HMO |
$828.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$342.24
|
| Rate for Payer: PHCS Commercial |
$1,059.84
|
| Rate for Payer: United Healthcare All Payer |
$971.52
|
|
