|
MANIPULATE ELBOW W ANESTHESIA
|
Facility
|
IP
|
$635.00
|
|
|
Service Code
|
HCPCS 24300
|
| Hospital Charge Code |
76100517
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$190.50 |
| 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 |
$508.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$438.15
|
| Rate for Payer: PHCS Commercial |
$609.60
|
| Rate for Payer: United Healthcare All Payer |
$558.80
|
|
|
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 |
$621.07 |
| Rate for Payer: Aetna Commercial |
$551.69
|
| Rate for Payer: Ambetter Exchange |
$420.03
|
| Rate for Payer: Anthem Medicaid |
$261.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$420.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$420.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$504.04
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$420.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.03
|
| 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 |
$546.04
|
| Rate for Payer: UHCCP Medicaid |
$222.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$264.47
|
| Rate for Payer: Wellcare Medicare Advantage |
$420.03
|
|
|
MANIPULATE FINGER W/ANESTH
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
76100686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.58 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
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 |
$482.95 |
| Rate for Payer: Aetna Commercial |
$427.88
|
| Rate for Payer: Ambetter Exchange |
$341.03
|
| Rate for Payer: Anthem Medicaid |
$196.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$341.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$341.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$409.24
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$341.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.03
|
| 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 |
$443.34
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$341.03
|
|
|
MANIPULATE FINGER W/ANESTH
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 26340
|
| Hospital Charge Code |
76100686
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.00 |
| 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 |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| 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 |
$482.95 |
| Rate for Payer: Aetna Commercial |
$427.88
|
| Rate for Payer: Ambetter Exchange |
$341.03
|
| Rate for Payer: Anthem Medicaid |
$196.88
|
| Rate for Payer: Buckeye Individual/Medicaid |
$341.03
|
| Rate for Payer: Buckeye Medicare Advantage |
$341.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$409.24
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$341.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.03
|
| 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 |
$443.34
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$198.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$341.03
|
|
|
MANIPULATE WST UNDER ANESTH
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
76100597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$240.73 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$539.00
|
| Rate for Payer: Anthem Medicaid |
$240.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$546.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| 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 |
$1,478.75
|
| 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 |
$1,774.50
|
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
MANIPULATE WST UNDER ANESTH
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
HCPCS 25259
|
| Hospital Charge Code |
76100597
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.00 |
| 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 |
$560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.00
|
| Rate for Payer: PHCS Commercial |
$672.00
|
| Rate for Payer: United Healthcare All Payer |
$616.00
|
|
|
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 |
$619.13 |
| Rate for Payer: Aetna Commercial |
$552.23
|
| Rate for Payer: Ambetter Exchange |
$399.71
|
| Rate for Payer: Anthem Medicaid |
$259.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$399.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$399.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$479.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$399.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.71
|
| 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 |
$519.62
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$399.71
|
|
|
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 |
$619.13 |
| Rate for Payer: Aetna Commercial |
$552.23
|
| Rate for Payer: Ambetter Exchange |
$399.71
|
| Rate for Payer: Anthem Medicaid |
$259.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$399.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$399.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$479.65
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$399.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.71
|
| 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 |
$519.62
|
| Rate for Payer: UHCCP Medicaid |
$245.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$261.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$399.71
|
|
|
MANIPULATION 1-2 BODY REGION(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
761P2506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Ambetter Exchange |
$21.48
|
| 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 Individual/Medicaid |
$21.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.78
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$21.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Passport |
$20.40
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.92
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.48
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
76102506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$11.94 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$22.33
|
| Rate for Payer: Ambetter Exchange |
$21.48
|
| 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 Individual/Medicaid |
$21.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.78
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$21.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.81
|
| Rate for Payer: Molina Healthcare Passport |
$20.40
|
| Rate for Payer: Multiplan PHCS |
$55.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.92
|
| Rate for Payer: UHCCP Medicaid |
$12.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.48
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
45000314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.10 |
| 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 |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
76102506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
76102506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
MANIPULATION 1-2 BODY REGIONS
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
45000314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.16 |
| 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 |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$36.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| 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 |
$23.38
|
| 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 |
$37.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$32.43
|
| Rate for Payer: PHCS Commercial |
$45.12
|
| Rate for Payer: United Healthcare All Payer |
$41.36
|
|
|
MANIPULATION 1-2 BODY REGION(T
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
761T2506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem Medicaid |
$16.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Humana KY Medicaid |
$16.51
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$16.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$16.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
MANIPULATION 1-2 BODY REGION(T
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS 98925
|
| Hospital Charge Code |
761T2506
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$46.08 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$37.44
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$39.84
|
| Rate for Payer: First Health Commercial |
$45.60
|
| Rate for Payer: Humana Commercial |
$40.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$39.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$35.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$42.24
|
| Rate for Payer: Ohio Health Group HMO |
$36.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.12
|
| Rate for Payer: PHCS Commercial |
$46.08
|
| Rate for Payer: United Healthcare All Payer |
$42.24
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
45000315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
45000315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
76102507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
MANIPULATION 3-5 REGIONS
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
76102507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
MANIPULATION 3-5 REGIONS
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
76102507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Ambetter Exchange |
$32.55
|
| 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 Individual/Medicaid |
$32.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$32.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.31
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.55
|
|
|
MANIPULATION 3-5 REGIONS(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
761P2507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Ambetter Exchange |
$32.55
|
| 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 Individual/Medicaid |
$32.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$32.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.06
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$32.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.14
|
| Rate for Payer: Molina Healthcare Passport |
$30.53
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.31
|
| Rate for Payer: UHCCP Medicaid |
$18.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$32.55
|
|
|
MANIPULATION 3-5 REGIONS(T
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
761T2507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$47.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.95
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
