|
MANIPULATION 3-5 REGIONS(T
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 98926
|
| Hospital Charge Code |
761T2507
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$23.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$32.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$31.56
|
| Rate for Payer: Cash Price |
$27.50
|
| 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: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Humana Medicare Advantage |
$23.38
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| 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 |
$28.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| 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
|
|
|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$2,070.25
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,478.75 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
|
|
MANNITOL 20% (FS) 500ML
|
Facility
|
OP
|
$332.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003199
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$99.62 |
| 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 |
$265.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.12
|
| Rate for Payer: PHCS Commercial |
$318.78
|
| Rate for Payer: United Healthcare All Payer |
$292.21
|
|
|
MANNITOL 20% (FS) 500ML
|
Facility
|
IP
|
$332.06
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003199
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$99.62 |
| 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 |
$265.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.12
|
| 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 |
$4.37 |
| 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 |
$4.37
|
| 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 |
$11.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.04
|
| 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 |
$4.37 |
| 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 |
$4.37
|
| 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 |
$11.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.04
|
| 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 |
$10.50 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| 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 |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| 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: Aetna Commercial |
$26.95
|
| Rate for Payer: Anthem Medicaid |
$4.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$28.11
|
| 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 |
$28.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.15
|
| Rate for Payer: PHCS Commercial |
$33.60
|
| Rate for Payer: United Healthcare All Payer |
$30.80
|
|
|
MANUAL DIFF
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
30000565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
MANUAL DIFF
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
30000565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Ambetter Exchange |
$3.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$4.56
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$4.98
|
| Rate for Payer: Healthspan PPO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.80
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.94
|
| Rate for Payer: UHCCP Medicaid |
$23.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$2.28
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.80
|
|
|
MANUAL DIFF
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
30000565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$3.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| 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 |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Anthem Medicaid |
$48.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.98
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: First Health Commercial |
$133.95
|
| Rate for Payer: Humana Commercial |
$119.85
|
| Rate for Payer: Humana KY Medicaid |
$48.49
|
| Rate for Payer: Kentucky WC Medicaid |
$48.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$115.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.08
|
| Rate for Payer: Ohio Health Group HMO |
$105.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.29
|
| Rate for Payer: PHCS Commercial |
$135.36
|
| Rate for Payer: United Healthcare All Payer |
$124.08
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.98
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: First Health Commercial |
$133.95
|
| Rate for Payer: Humana Commercial |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$115.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.08
|
| Rate for Payer: Ohio Health Group HMO |
$105.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.29
|
| Rate for Payer: PHCS Commercial |
$135.36
|
| Rate for Payer: United Healthcare All Payer |
$124.08
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
43000017
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Anthem Medicaid |
$48.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.98
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: First Health Commercial |
$133.95
|
| Rate for Payer: Humana Commercial |
$119.85
|
| Rate for Payer: Humana KY Medicaid |
$48.49
|
| Rate for Payer: Kentucky WC Medicaid |
$48.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$115.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.08
|
| Rate for Payer: Ohio Health Group HMO |
$105.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.29
|
| Rate for Payer: PHCS Commercial |
$135.36
|
| Rate for Payer: United Healthcare All Payer |
$124.08
|
|
|
MANUAL THERAPY - 15 MIN
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
42000023
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$108.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.98
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$117.03
|
| Rate for Payer: First Health Commercial |
$133.95
|
| Rate for Payer: Humana Commercial |
$119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$115.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$104.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$124.08
|
| Rate for Payer: Ohio Health Group HMO |
$105.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.29
|
| Rate for Payer: PHCS Commercial |
$135.36
|
| Rate for Payer: United Healthcare All Payer |
$124.08
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
IP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,115.40 |
| Max. Negotiated Rate |
$3,569.28 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$3,085.94
|
| Rate for Payer: First Health Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial |
$3,160.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.42
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
OP
|
$3,718.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,278.62 |
| Max. Negotiated Rate |
$3,569.28 |
| Rate for Payer: Aetna Commercial |
$2,862.86
|
| Rate for Payer: Anthem Medicaid |
$1,278.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.04
|
| 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 |
$1,859.00
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$3,085.94
|
| Rate for Payer: First Health Commercial |
$3,532.10
|
| Rate for Payer: Humana Commercial |
$3,160.30
|
| Rate for Payer: Humana KY Medicaid |
$1,278.62
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.42
|
| Rate for Payer: PHCS Commercial |
$3,569.28
|
| Rate for Payer: United Healthcare All Payer |
$3,271.84
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
761T0492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$957.90 |
| Max. Negotiated Rate |
$3,065.28 |
| Rate for Payer: Aetna Commercial |
$2,458.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.54
|
| Rate for Payer: Cash Price |
$1,596.50
|
| Rate for Payer: Cigna Commercial |
$2,650.19
|
| Rate for Payer: First Health Commercial |
$3,033.35
|
| Rate for Payer: Humana Commercial |
$2,714.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,618.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,777.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$3,065.28
|
| Rate for Payer: United Healthcare All Payer |
$2,809.84
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
761T0492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,098.07 |
| Max. Negotiated Rate |
$3,065.28 |
| Rate for Payer: Aetna Commercial |
$2,458.61
|
| Rate for Payer: Anthem Medicaid |
$1,098.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.54
|
| 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 |
$1,596.50
|
| Rate for Payer: Cash Price |
$1,596.50
|
| Rate for Payer: Cigna Commercial |
$2,650.19
|
| Rate for Payer: First Health Commercial |
$3,033.35
|
| Rate for Payer: Humana Commercial |
$2,714.05
|
| Rate for Payer: Humana KY Medicaid |
$1,098.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,618.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,120.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,777.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,203.17
|
| Rate for Payer: PHCS Commercial |
$3,065.28
|
| Rate for Payer: United Healthcare All Payer |
$2,809.84
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
761P0492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$284.99
|
| Rate for Payer: Ambetter Exchange |
$186.77
|
| Rate for Payer: Anthem Medicaid |
$136.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.12
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Healthspan PPO |
$258.14
|
| Rate for Payer: Humana Medicaid |
$136.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$239.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.54
|
| Rate for Payer: Molina Healthcare Passport |
$136.80
|
| Rate for Payer: Multiplan PHCS |
$315.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$242.80
|
| Rate for Payer: UHCCP Medicaid |
$183.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.77
|
|
|
MAN W/ANES SHLDR JNT W/FIX APP
|
Professional
|
Both
|
$3,718.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
76100492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$2,230.80 |
| Rate for Payer: Aetna Commercial |
$284.99
|
| Rate for Payer: Ambetter Exchange |
$186.77
|
| Rate for Payer: Anthem Medicaid |
$136.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$186.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$186.77
|
| Rate for Payer: CareSource Just4Me Medicare |
$224.12
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cash Price |
$1,859.00
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Healthspan PPO |
$258.14
|
| Rate for Payer: Humana Medicaid |
$136.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$239.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$186.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.54
|
| Rate for Payer: Molina Healthcare Passport |
$136.80
|
| Rate for Payer: Multiplan PHCS |
$2,230.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$242.80
|
| Rate for Payer: UHCCP Medicaid |
$1,301.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$186.77
|
|
|
MAPLE TREE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000918
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
MAPLE TREE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000918
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
MARCAINE(BUPIVACAIN)0.25% 30ML
|
Facility
|
OP
|
$114.52
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
25003200
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$109.94 |
| Rate for Payer: Aetna Commercial |
$88.18
|
| Rate for Payer: Anthem Medicaid |
$39.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.33
|
| Rate for Payer: Cash Price |
$57.26
|
| Rate for Payer: Cigna Commercial |
$95.05
|
| Rate for Payer: First Health Commercial |
$108.79
|
| Rate for Payer: Humana Commercial |
$97.34
|
| Rate for Payer: Humana KY Medicaid |
$39.38
|
| Rate for Payer: Kentucky WC Medicaid |
$39.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.78
|
| Rate for Payer: Ohio Health Group HMO |
$85.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.02
|
| Rate for Payer: PHCS Commercial |
$109.94
|
| Rate for Payer: United Healthcare All Payer |
$100.78
|
|
