|
MD CERTIFICATION HHA PATIENT
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
51000152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$74.01 |
| Rate for Payer: Aetna Commercial |
$30.93
|
| Rate for Payer: Ambetter Exchange |
$49.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$49.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$49.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$59.44
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.01
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$49.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.53
|
| Rate for Payer: Multiplan PHCS |
$64.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$64.39
|
| Rate for Payer: UHCCP Medicaid |
$37.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$49.53
|
|
|
MD INR TEST REVIE INTER MGMT
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
76102637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.60
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna Commercial |
$16.60
|
| Rate for Payer: First Health Commercial |
$19.00
|
| Rate for Payer: Humana Commercial |
$17.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.60
|
| Rate for Payer: Ohio Health Group HMO |
$15.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.80
|
| Rate for Payer: PHCS Commercial |
$19.20
|
| Rate for Payer: United Healthcare All Payer |
$17.60
|
|
|
MD INR TEST REVIE INTER MGMT
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
761P2637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna Commercial |
$15.38
|
| Rate for Payer: Ambetter Exchange |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$7.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.86
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Humana Medicaid |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.58
|
| Rate for Payer: Molina Healthcare Passport |
$7.43
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.69
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.22
|
|
|
MD INR TEST REVIE INTER MGMT
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
76102637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$15.38 |
| Rate for Payer: Aetna Commercial |
$15.38
|
| Rate for Payer: Ambetter Exchange |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$7.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.86
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Humana Medicaid |
$7.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.58
|
| Rate for Payer: Molina Healthcare Passport |
$7.43
|
| Rate for Payer: Multiplan PHCS |
$12.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.69
|
| Rate for Payer: UHCCP Medicaid |
$7.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.50
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.22
|
|
|
MD INR TEST REVIE INTER MGMT
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS G0250
|
| Hospital Charge Code |
76102637
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Aetna Commercial |
$15.40
|
| Rate for Payer: Anthem Medicaid |
$6.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15.60
|
| Rate for Payer: Cash Price |
$10.00
|
| Rate for Payer: Cigna Commercial |
$16.60
|
| Rate for Payer: First Health Commercial |
$19.00
|
| Rate for Payer: Humana Commercial |
$17.00
|
| Rate for Payer: Humana KY Medicaid |
$6.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$17.60
|
| Rate for Payer: Ohio Health Group HMO |
$15.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.80
|
| Rate for Payer: PHCS Commercial |
$19.20
|
| Rate for Payer: United Healthcare All Payer |
$17.60
|
|
|
MD RECERTIFICATION HHA PT
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
51000151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.94
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
MD RECERTIFICATION HHA PT
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
51000151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$25.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$56.94
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Humana KY Medicaid |
$25.10
|
| Rate for Payer: Kentucky WC Medicaid |
$25.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
MD RECERTIFICATION HHA PT
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
51000151
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna Commercial |
$23.31
|
| Rate for Payer: Ambetter Exchange |
$38.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.61
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Healthspan PPO |
$67.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.84
|
| Rate for Payer: Multiplan PHCS |
$43.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$50.49
|
| Rate for Payer: UHCCP Medicaid |
$25.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.84
|
|
|
MD SERVICE REQUIRED FOR PMD
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0372
|
| Hospital Charge Code |
51000139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Ambetter Exchange |
$8.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.83
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.19
|
| Rate for Payer: Multiplan PHCS |
$18.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.65
|
| Rate for Payer: UHCCP Medicaid |
$10.85
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.19
|
|
|
MEASLESMUMPSAND RUBELLA 1EA
|
Facility
|
IP
|
$361.95
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
25000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.58 |
| Max. Negotiated Rate |
$347.47 |
| Rate for Payer: Aetna Commercial |
$278.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$282.32
|
| Rate for Payer: Cash Price |
$180.98
|
| Rate for Payer: Cigna Commercial |
$300.42
|
| Rate for Payer: First Health Commercial |
$343.85
|
| Rate for Payer: Humana Commercial |
$307.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$318.52
|
| Rate for Payer: Ohio Health Group HMO |
$271.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.75
|
| Rate for Payer: PHCS Commercial |
$347.47
|
| Rate for Payer: United Healthcare All Payer |
$318.52
|
|
|
MEASLESMUMPSAND RUBELLA 1EA
|
Facility
|
OP
|
$361.95
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
25000037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.58 |
| Max. Negotiated Rate |
$347.47 |
| Rate for Payer: Aetna Commercial |
$278.70
|
| Rate for Payer: Anthem Medicaid |
$124.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$282.32
|
| Rate for Payer: Cash Price |
$180.98
|
| Rate for Payer: Cigna Commercial |
$300.42
|
| Rate for Payer: First Health Commercial |
$343.85
|
| Rate for Payer: Humana Commercial |
$307.66
|
| Rate for Payer: Humana KY Medicaid |
$124.47
|
| Rate for Payer: Kentucky WC Medicaid |
$125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$267.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$318.52
|
| Rate for Payer: Ohio Health Group HMO |
$271.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$289.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.75
|
| Rate for Payer: PHCS Commercial |
$347.47
|
| Rate for Payer: United Healthcare All Payer |
$318.52
|
|
|
MEASLES (RUBEOLA) IGG
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
30001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
MEASLES (RUBEOLA) IGG
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
HCPCS 86765
|
| Hospital Charge Code |
30001212
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$171.84 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Anthem Medicaid |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cash Price |
$89.50
|
| Rate for Payer: Cigna Commercial |
$148.57
|
| Rate for Payer: First Health Commercial |
$170.05
|
| Rate for Payer: Humana Commercial |
$152.15
|
| Rate for Payer: Humana KY Medicaid |
$12.88
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$13.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$146.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$157.52
|
| Rate for Payer: Ohio Health Group HMO |
$134.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$143.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$123.51
|
| Rate for Payer: PHCS Commercial |
$171.84
|
| Rate for Payer: United Healthcare All Payer |
$157.52
|
|
|
MEASURE BLD OXYGEN LEVEL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$11.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.70
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$12.45
|
| Rate for Payer: First Health Commercial |
$14.25
|
| Rate for Payer: Humana Commercial |
$12.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.20
|
| Rate for Payer: Ohio Health Group HMO |
$11.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.35
|
| Rate for Payer: PHCS Commercial |
$14.40
|
| Rate for Payer: United Healthcare All Payer |
$13.20
|
|
|
MEASURE BLD OXYGEN LEVEL
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna Commercial |
$4.63
|
| Rate for Payer: Ambetter Exchange |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$7.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$3.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$3.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.94
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$3.89
|
| Rate for Payer: Healthspan PPO |
$3.58
|
| Rate for Payer: Humana Medicaid |
$7.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.33
|
| Rate for Payer: Molina Healthcare Passport |
$7.19
|
| Rate for Payer: Multiplan PHCS |
$9.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4.26
|
| Rate for Payer: UHCCP Medicaid |
$5.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$3.28
|
|
|
MEASURE BLD OXYGEN LEVEL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
HCPCS 94760
|
| Hospital Charge Code |
46000016
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: Aetna Commercial |
$11.55
|
| Rate for Payer: Anthem Medicaid |
$5.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11.70
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$12.45
|
| Rate for Payer: First Health Commercial |
$14.25
|
| Rate for Payer: Humana Commercial |
$12.75
|
| Rate for Payer: Humana KY Medicaid |
$5.16
|
| Rate for Payer: Kentucky WC Medicaid |
$5.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$13.20
|
| Rate for Payer: Ohio Health Group HMO |
$11.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10.35
|
| Rate for Payer: PHCS Commercial |
$14.40
|
| Rate for Payer: United Healthcare All Payer |
$13.20
|
|
|
MECHANICAL PERCUSSION EA SESS
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 94669
|
| Hospital Charge Code |
41000084
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
MECHANICAL PERCUSSION EA SESS
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 94669
|
| Hospital Charge Code |
41000084
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
MECHANICAL TRACTION
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$46.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$46.43
|
| Rate for Payer: Kentucky WC Medicaid |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
MECHANICAL TRACTION
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$46.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$46.43
|
| Rate for Payer: Kentucky WC Medicaid |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
MECHANICAL TRACTION
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
43000003
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
MECHANICAL TRACTION
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97012
|
| Hospital Charge Code |
42000006
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
MECH REMVL PERICTH OBSTMAT
|
Professional
|
Both
|
$1,093.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
76102442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$31.17 |
| Max. Negotiated Rate |
$656.26 |
| Rate for Payer: Aetna Commercial |
$275.00
|
| Rate for Payer: Ambetter Exchange |
$197.86
|
| Rate for Payer: Anthem Medicaid |
$70.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.43
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cigna Commercial |
$189.41
|
| Rate for Payer: Healthspan PPO |
$257.69
|
| Rate for Payer: Humana Medicaid |
$70.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$31.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$197.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.76
|
| Rate for Payer: Molina Healthcare Passport |
$70.35
|
| Rate for Payer: Multiplan PHCS |
$656.26
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$257.22
|
| Rate for Payer: UHCCP Medicaid |
$382.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.86
|
|
|
MECH REMVL PERICTH OBSTMAT
|
Facility
|
OP
|
$1,093.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
76102442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.13 |
| Max. Negotiated Rate |
$1,050.02 |
| Rate for Payer: Aetna Commercial |
$842.20
|
| Rate for Payer: Anthem Medicaid |
$376.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.14
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cigna Commercial |
$907.83
|
| Rate for Payer: First Health Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial |
$929.70
|
| Rate for Payer: Humana KY Medicaid |
$376.15
|
| Rate for Payer: Kentucky WC Medicaid |
$379.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$896.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$383.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$962.52
|
| Rate for Payer: Ohio Health Group HMO |
$820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$951.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$754.70
|
| Rate for Payer: PHCS Commercial |
$1,050.02
|
| Rate for Payer: United Healthcare All Payer |
$962.52
|
|
|
MECH REMVL PERICTH OBSTMAT
|
Facility
|
IP
|
$1,093.77
|
|
|
Service Code
|
HCPCS 75901
|
| Hospital Charge Code |
76102442
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$328.13 |
| Max. Negotiated Rate |
$1,050.02 |
| Rate for Payer: Aetna Commercial |
$842.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$853.14
|
| Rate for Payer: Cash Price |
$546.88
|
| Rate for Payer: Cigna Commercial |
$907.83
|
| Rate for Payer: First Health Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial |
$929.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$896.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$807.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$328.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$962.52
|
| Rate for Payer: Ohio Health Group HMO |
$820.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$951.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$754.70
|
| Rate for Payer: PHCS Commercial |
$1,050.02
|
| Rate for Payer: United Healthcare All Payer |
$962.52
|
|
