|
MANIPULATION 1-2 BODY REGION(T
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$35.10
|
| 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: 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 |
$13.50
|
| 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
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
45000315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
76102507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
76102507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$112.32 |
| Rate for Payer: Aetna Commercial |
$90.09
|
| Rate for Payer: Anthem Medicaid |
$40.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$97.11
|
| Rate for Payer: First Health Commercial |
$111.15
|
| Rate for Payer: Humana Commercial |
$99.45
|
| Rate for Payer: Humana KY Medicaid |
$40.24
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$40.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$86.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.96
|
| Rate for Payer: Ohio Health Group HMO |
$87.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.27
|
| Rate for Payer: PHCS Commercial |
$112.32
|
| Rate for Payer: United Healthcare All Payer |
$102.96
|
|
|
MANIPULATION 3-5 REGIONS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
76102507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$30.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna Commercial |
$52.96
|
| Rate for Payer: Humana Medicaid |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$70.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$81.90
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
45000315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
MANIPULATION 3-5 REGIONS(P
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
761P2507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.82
|
| Rate for Payer: Anthem Medicaid |
$30.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.00
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cigna Commercial |
$52.96
|
| Rate for Payer: Humana Medicaid |
$30.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.50
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
|
|
MANIPULATION 3-5 REGIONS(T
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
761T2507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
MANIPULATION 3-5 REGIONS(T
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
761T2507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.12
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$1,945.78
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,389.84 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
|
|
MANNITOL 20% (FS) 500ML
|
Facility
|
IP
|
$332.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$318.78 |
| Rate for Payer: Aetna Commercial |
$255.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.01
|
| Rate for Payer: Cash Price |
$166.03
|
| Rate for Payer: Cigna Commercial |
$275.61
|
| Rate for Payer: First Health Commercial |
$315.46
|
| Rate for Payer: Humana Commercial |
$282.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.21
|
| Rate for Payer: Ohio Health Group HMO |
$249.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.94
|
| Rate for Payer: PHCS Commercial |
$318.78
|
| Rate for Payer: United Healthcare All Payer |
$292.21
|
|
|
MANNITOL 20% (FS) 500ML
|
Facility
|
OP
|
$332.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$318.78 |
| Rate for Payer: Aetna Commercial |
$255.69
|
| Rate for Payer: Anthem Medicaid |
$114.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.01
|
| Rate for Payer: Cash Price |
$166.03
|
| Rate for Payer: Cigna Commercial |
$275.61
|
| Rate for Payer: First Health Commercial |
$315.46
|
| Rate for Payer: Humana Commercial |
$282.25
|
| Rate for Payer: Humana KY Medicaid |
$114.20
|
| Rate for Payer: Kentucky WC Medicaid |
$115.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.21
|
| Rate for Payer: Ohio Health Group HMO |
$249.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.94
|
| Rate for Payer: PHCS Commercial |
$318.78
|
| Rate for Payer: United Healthcare All Payer |
$292.21
|
|
|
MANNITOL 25% 12.5G 12.5GM/50ML
|
Facility
|
OP
|
$14.55
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
25002221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Aetna Commercial |
$11.20
|
| Rate for Payer: Anthem Medicaid |
$5.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.35
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cigna Commercial |
$12.08
|
| Rate for Payer: First Health Commercial |
$13.82
|
| Rate for Payer: Humana Commercial |
$12.37
|
| Rate for Payer: Humana KY Medicaid |
$5.00
|
| Rate for Payer: Kentucky WC Medicaid |
$5.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.80
|
| Rate for Payer: Ohio Health Group HMO |
$10.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.51
|
| Rate for Payer: PHCS Commercial |
$13.97
|
| Rate for Payer: United Healthcare All Payer |
$12.80
|
|
|
MANNITOL 25% 12.5G 12.5GM/50ML
|
Facility
|
IP
|
$14.55
|
|
|
Service Code
|
HCPCS J2150
|
| Hospital Charge Code |
25002221
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$13.97 |
| Rate for Payer: Aetna Commercial |
$11.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.35
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cigna Commercial |
$12.08
|
| Rate for Payer: First Health Commercial |
$13.82
|
| Rate for Payer: Humana Commercial |
$12.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$12.80
|
| Rate for Payer: Ohio Health Group HMO |
$10.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4.51
|
| Rate for Payer: PHCS Commercial |
$13.97
|
| Rate for Payer: United Healthcare All Payer |
$12.80
|
|
|
MANUAL CELL CNT (WBC) FLUID
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
30000571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.10
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
MANUAL CELL CNT (WBC) FLUID
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS 85032
|
| Hospital Charge Code |
30000571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.10
|
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$4.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.31
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$29.05
|
| Rate for Payer: First Health Commercial |
$33.25
|
| Rate for Payer: Humana Commercial |
$29.75
|
| Rate for Payer: Humana KY Medicaid |
$4.31
|
| Rate for Payer: Humana Medicare Advantage |
$4.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$28.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$25.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$30.80
|
| Rate for Payer: Ohio Health Group HMO |
$26.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.85
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
MANUAL DIFF
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
30000565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$4.98
|
| Rate for Payer: Healthspan PPO |
$3.61
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.28
|
|
|
MANUAL DIFF
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
30000565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.59
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
MANUAL DIFF
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
30000565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem Medicaid |
$3.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Humana KY Medicaid |
$3.80
|
| Rate for Payer: Humana Medicare Advantage |
$3.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.53
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$45.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$45.39
|
| Rate for Payer: Kentucky WC Medicaid |
$45.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem Medicaid |
$45.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Humana KY Medicaid |
$45.39
|
| Rate for Payer: Kentucky WC Medicaid |
$45.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$126.72 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.96
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$109.56
|
| Rate for Payer: First Health Commercial |
$125.40
|
| Rate for Payer: Humana Commercial |
$112.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$108.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$116.16
|
| Rate for Payer: Ohio Health Group HMO |
$99.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$26.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.92
|
| Rate for Payer: PHCS Commercial |
$126.72
|
| Rate for Payer: United Healthcare All Payer |
$116.16
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
IP
|
$3,192.53
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
761T0492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$415.03 |
| Max. Negotiated Rate |
$3,064.83 |
| Rate for Payer: Aetna Commercial |
$2,458.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.17
|
| Rate for Payer: Cash Price |
$1,596.27
|
| Rate for Payer: Cigna Commercial |
$2,649.80
|
| Rate for Payer: First Health Commercial |
$3,032.90
|
| Rate for Payer: Humana Commercial |
$2,713.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,617.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$989.68
|
| Rate for Payer: PHCS Commercial |
$3,064.83
|
| Rate for Payer: United Healthcare All Payer |
$2,809.43
|
|
