|
MANDIBLES COMPLETE 4V
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| 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 Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$275.00
|
| 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: Humana Medicare Advantage |
$95.07
|
| 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 |
$114.08
|
| 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
|
|
|
MANDIBLES COMPLETE 4V
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| 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
|
|
|
MANDIBLES COMPLETE 4V
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
32000011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Anthem Medicaid |
$27.84
|
| 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 |
$55.53
|
| Rate for Payer: Healthspan PPO |
$55.98
|
| Rate for Payer: Humana Medicaid |
$27.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.40
|
| Rate for Payer: Molina Healthcare Passport |
$27.84
|
| 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 |
$28.12
|
|
|
MANDIBLES COMPLETE 4V(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
320P0011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$59.74
|
| Rate for Payer: Anthem Medicaid |
$27.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$55.53
|
| Rate for Payer: Healthspan PPO |
$55.98
|
| Rate for Payer: Humana Medicaid |
$27.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$28.40
|
| Rate for Payer: Molina Healthcare Passport |
$27.84
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$28.12
|
|
|
MANDIBLES COMPLETE 4V(T
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
320T0011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
MANDIBLES COMPLETE 4V(T
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS 70110
|
| Hospital Charge Code |
320T0011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.75 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Anthem Medicaid |
$163.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$370.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cash Price |
$237.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: First Health Commercial |
$451.25
|
| Rate for Payer: Humana Commercial |
$403.75
|
| Rate for Payer: Humana KY Medicaid |
$163.35
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$165.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$389.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$350.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$166.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$418.00
|
| Rate for Payer: Ohio Health Group HMO |
$356.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$95.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.25
|
| Rate for Payer: PHCS Commercial |
$456.00
|
| Rate for Payer: United Healthcare All Payer |
$418.00
|
|
|
MANIPULATE ELBOW W ANESTHESIA
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 24300
|
| Hospital Charge Code |
76100517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$609.60 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.30
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
MANIPULATE ELBOW W ANESTHESIA
|
Facility
|
OP
|
$635.00
|
|
|
Service Code
|
HCPCS 24300
|
| Hospital Charge Code |
76100517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.55 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$488.95
|
| Rate for Payer: Anthem Medicaid |
$218.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$495.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$527.05
|
| Rate for Payer: First Health Commercial |
$603.25
|
| Rate for Payer: Humana Commercial |
$539.75
|
| Rate for Payer: Humana KY Medicaid |
$218.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$520.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$468.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$558.80
|
| Rate for Payer: Ohio Health Group HMO |
$476.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$127.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.85
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
MANIPULATE ELBOW W ANESTHESIA
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 24300
|
| Hospital Charge Code |
76100517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: Aetna Commercial |
$551.69
|
| Rate for Payer: Anthem Medicaid |
$261.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.00
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$621.07
|
| Rate for Payer: Healthspan PPO |
$499.71
|
| Rate for Payer: Humana Medicaid |
$261.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$487.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.09
|
| Rate for Payer: Molina Healthcare Passport |
$261.85
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.50
|
| Rate for Payer: UHCCP Medicaid |
$222.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.47
|
|
|
MANIPULATE ELBOW W ANESTHESI(P
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 24300
|
| Hospital Charge Code |
761P0517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$635.00 |
| Rate for Payer: Aetna Commercial |
$551.69
|
| Rate for Payer: Anthem Medicaid |
$261.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$635.00
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cash Price |
$317.50
|
| Rate for Payer: Cigna Commercial |
$621.07
|
| Rate for Payer: Healthspan PPO |
$499.71
|
| Rate for Payer: Humana Medicaid |
$261.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$487.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$267.09
|
| Rate for Payer: Molina Healthcare Passport |
$261.85
|
| Rate for Payer: Multiplan PHCS |
$381.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$444.50
|
| Rate for Payer: UHCCP Medicaid |
$222.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.47
|
|
|
MANIPULATE FINGER W/ANESTH
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
76100686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$427.88
|
| Rate for Payer: Anthem Medicaid |
$196.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$482.95
|
| Rate for Payer: Healthspan PPO |
$387.57
|
| Rate for Payer: Humana Medicaid |
$196.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$392.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.82
|
| Rate for Payer: Molina Healthcare Passport |
$196.88
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.85
|
|
|
MANIPULATE FINGER W/ANESTH
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
76100686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
MANIPULATE FINGER W/ANESTH
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
76100686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
MANIPULATE FINGER W/ANESTH(P
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
761P0686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$427.88
|
| Rate for Payer: Anthem Medicaid |
$196.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$482.95
|
| Rate for Payer: Healthspan PPO |
$387.57
|
| Rate for Payer: Humana Medicaid |
$196.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$392.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$200.82
|
| Rate for Payer: Molina Healthcare Passport |
$196.88
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.85
|
|
|
MANIPULATE WST UNDER ANESTH
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
76100597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$552.23
|
| Rate for Payer: Anthem Medicaid |
$259.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$619.13
|
| Rate for Payer: Healthspan PPO |
$500.21
|
| Rate for Payer: Humana Medicaid |
$259.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$490.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.19
|
| Rate for Payer: Molina Healthcare Passport |
$259.01
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.60
|
|
|
MANIPULATE WST UNDER ANESTH
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
76100597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$210.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
MANIPULATE WST UNDER ANESTH
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
76100597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$581.00
|
| Rate for Payer: First Health Commercial |
$665.00
|
| Rate for Payer: Humana Commercial |
$595.00
|
| Rate for Payer: Humana KY Medicaid |
$240.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$243.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$574.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$516.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$245.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$616.00
|
| Rate for Payer: Ohio Health Group HMO |
$525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$91.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
MANIPULATE WST UNDER ANESTH(P
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
761P0597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$552.23
|
| Rate for Payer: Anthem Medicaid |
$259.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$700.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cash Price |
$350.00
|
| Rate for Payer: Cigna Commercial |
$619.13
|
| Rate for Payer: Healthspan PPO |
$500.21
|
| Rate for Payer: Humana Medicaid |
$259.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$490.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$264.19
|
| Rate for Payer: Molina Healthcare Passport |
$259.01
|
| Rate for Payer: Multiplan PHCS |
$420.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.00
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.60
|
|
|
MANIPULATION 1-2 BODY REGION(P
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
761P2506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.94
|
| Rate for Payer: Anthem Medicaid |
$20.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$45.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$38.26
|
| Rate for Payer: Humana Medicaid |
$20.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Passport |
$20.40
|
| Rate for Payer: Multiplan PHCS |
$27.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.50
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.60
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
45000314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.66
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
76102506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$11.94
|
| Rate for Payer: Anthem Medicaid |
$20.40
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$38.26
|
| Rate for Payer: Humana Medicaid |
$20.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$29.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Passport |
$20.40
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.60
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
45000314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.11 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Anthem Medicaid |
$16.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna Commercial |
$39.01
|
| Rate for Payer: First Health Commercial |
$44.65
|
| Rate for Payer: Humana Commercial |
$39.95
|
| Rate for Payer: Humana KY Medicaid |
$16.16
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$16.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$38.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$34.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$41.36
|
| Rate for Payer: Ohio Health Group HMO |
$35.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14.57
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
76102506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
76102506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.90
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
MANIPULATION 1-2 BODY REGION(T
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
761T2506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$43.20 |
| Rate for Payer: Aetna Commercial |
$34.65
|
| Rate for Payer: Anthem Medicaid |
$15.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$35.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$37.35
|
| Rate for Payer: First Health Commercial |
$42.75
|
| Rate for Payer: Humana Commercial |
$38.25
|
| Rate for Payer: Humana KY Medicaid |
$15.48
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$15.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$33.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$39.60
|
| Rate for Payer: Ohio Health Group HMO |
$33.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.95
|
| Rate for Payer: PHCS Commercial |
$43.20
|
| Rate for Payer: United Healthcare All Payer |
$39.60
|
|
