|
MBT STEP WEDGE SZ 5 15MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 5 15MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 5 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 5 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 6 10MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 6 10MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 6 15MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 6 15MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 6 5MM
|
Facility
|
OP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem Medicaid |
$5,728.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Humana KY Medicaid |
$5,728.72
|
| Rate for Payer: Kentucky WC Medicaid |
$5,787.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,843.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MBT STEP WEDGE SZ 6 5MM
|
Facility
|
IP
|
$16,658.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,997.43 |
| Max. Negotiated Rate |
$15,991.78 |
| Rate for Payer: Aetna Commercial |
$12,826.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,993.32
|
| Rate for Payer: Cash Price |
$8,329.05
|
| Rate for Payer: Cigna Commercial |
$13,826.22
|
| Rate for Payer: First Health Commercial |
$15,825.19
|
| Rate for Payer: Humana Commercial |
$14,159.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,659.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,997.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,659.13
|
| Rate for Payer: Ohio Health Group HMO |
$12,493.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,326.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,492.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,494.09
|
| Rate for Payer: PHCS Commercial |
$15,991.78
|
| Rate for Payer: United Healthcare All Payer |
$14,659.13
|
|
|
MCCALL COLPOPEXY
|
Facility
|
OP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
76101865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem Medicaid |
$550.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Humana KY Medicaid |
$550.24
|
| Rate for Payer: Kentucky WC Medicaid |
$555.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
MCCALL COLPOPEXY
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
76101865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.75 |
| Max. Negotiated Rate |
$1,092.57 |
| Rate for Payer: Aetna Commercial |
$1,092.57
|
| Rate for Payer: Ambetter Exchange |
$737.88
|
| Rate for Payer: Anthem Medicaid |
$463.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$737.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$737.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$885.46
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,016.26
|
| Rate for Payer: Healthspan PPO |
$921.39
|
| Rate for Payer: Humana Medicaid |
$463.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$737.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$737.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.02
|
| Rate for Payer: Molina Healthcare Passport |
$463.75
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.24
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$737.88
|
|
|
MCCALL COLPOPEXY
|
Facility
|
IP
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
76101865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$1,232.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,248.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,328.00
|
| Rate for Payer: First Health Commercial |
$1,520.00
|
| Rate for Payer: Humana Commercial |
$1,360.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,312.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,180.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$480.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,408.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,200.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,392.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.00
|
| Rate for Payer: PHCS Commercial |
$1,536.00
|
| Rate for Payer: United Healthcare All Payer |
$1,408.00
|
|
|
MCCALL COLPOPEXY(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
761P1865
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$463.75 |
| Max. Negotiated Rate |
$1,092.57 |
| Rate for Payer: Aetna Commercial |
$1,092.57
|
| Rate for Payer: Ambetter Exchange |
$737.88
|
| Rate for Payer: Anthem Medicaid |
$463.75
|
| Rate for Payer: Buckeye Individual/Medicaid |
$737.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$737.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$885.46
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$1,016.26
|
| Rate for Payer: Healthspan PPO |
$921.39
|
| Rate for Payer: Humana Medicaid |
$463.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$966.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$737.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$737.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$473.02
|
| Rate for Payer: Molina Healthcare Passport |
$463.75
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$959.24
|
| Rate for Payer: UHCCP Medicaid |
$560.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$468.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$737.88
|
|
|
MCR ANNL WELLNESS VISIT INT
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
51000325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$254.66 |
| Rate for Payer: Aetna Commercial |
$254.66
|
| Rate for Payer: Ambetter Exchange |
$154.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$154.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.14
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$214.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$154.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.28
|
| Rate for Payer: Multiplan PHCS |
$179.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$200.56
|
| Rate for Payer: UHCCP Medicaid |
$104.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.28
|
|
|
MCR ANNL WELLNESS VISIT INT
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
510P0325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$254.66 |
| Rate for Payer: Aetna Commercial |
$254.66
|
| Rate for Payer: Ambetter Exchange |
$154.28
|
| Rate for Payer: Buckeye Individual/Medicaid |
$154.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$154.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$185.14
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$214.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$154.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.28
|
| Rate for Payer: Multiplan PHCS |
$179.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$200.56
|
| Rate for Payer: UHCCP Medicaid |
$104.65
|
| Rate for Payer: Wellcare Medicare Advantage |
$154.28
|
|
|
MCR ANNL WELLNESS VISIT INT
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
51000325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.31
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
MCR ANNL WELLNESS VISIT INT
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
51000325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.70 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem Medicaid |
$102.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Humana KY Medicaid |
$102.83
|
| Rate for Payer: Kentucky WC Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$206.31
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
MCV4 MENACWY VACCINE IM
|
Facility
|
OP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
77000048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Anthem Medicaid |
$201.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Humana KY Medicaid |
$201.04
|
| Rate for Payer: Kentucky WC Medicaid |
$203.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.37
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MCV4 MENACWY VACCINE IM
|
Facility
|
IP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
77000048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.37
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MCV4 MENACWY VACCINE IM
|
Professional
|
Both
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
77000048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.40 |
| Max. Negotiated Rate |
$409.22 |
| Rate for Payer: Anthem Medicaid |
$117.41
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Healthspan PPO |
$84.40
|
| Rate for Payer: Humana Medicaid |
$117.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$119.76
|
| Rate for Payer: Molina Healthcare Passport |
$117.41
|
| Rate for Payer: Multiplan PHCS |
$350.76
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$409.22
|
| Rate for Payer: UHCCP Medicaid |
$204.61
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$118.58
|
|
|
MCV4 MENACWY VACCINE IM(T
|
Facility
|
OP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
770T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Anthem Medicaid |
$201.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Humana KY Medicaid |
$201.04
|
| Rate for Payer: Kentucky WC Medicaid |
$203.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$205.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.37
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MCV4 MENACWY VACCINE IM(T
|
Facility
|
IP
|
$584.60
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
770T0048
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$561.22 |
| Rate for Payer: Aetna Commercial |
$450.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.99
|
| Rate for Payer: Cash Price |
$292.30
|
| Rate for Payer: Cigna Commercial |
$485.22
|
| Rate for Payer: First Health Commercial |
$555.37
|
| Rate for Payer: Humana Commercial |
$496.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$479.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$431.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$514.45
|
| Rate for Payer: Ohio Health Group HMO |
$438.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$467.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.37
|
| Rate for Payer: PHCS Commercial |
$561.22
|
| Rate for Payer: United Healthcare All Payer |
$514.45
|
|
|
MD CERTIFICATION HHA PATIENT
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
51000152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
MD CERTIFICATION HHA PATIENT
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
51000152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$36.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Humana KY Medicaid |
$36.80
|
| Rate for Payer: Kentucky WC Medicaid |
$37.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
