|
MOD ROT HINGE KNE FEM 10MM MED
|
Facility
|
IP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD ROT HINGE KNE FEM 10MM MED
|
Facility
|
OP
|
$4,386.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.28 |
| Max. Negotiated Rate |
$4,211.33 |
| Rate for Payer: Aetna Commercial |
$3,377.84
|
| Rate for Payer: Anthem Medicaid |
$1,508.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,421.70
|
| Rate for Payer: Cash Price |
$2,193.40
|
| Rate for Payer: Cigna Commercial |
$3,641.04
|
| Rate for Payer: First Health Commercial |
$4,167.46
|
| Rate for Payer: Humana Commercial |
$3,728.78
|
| Rate for Payer: Humana KY Medicaid |
$1,508.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,523.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,597.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,538.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,860.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,290.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.91
|
| Rate for Payer: PHCS Commercial |
$4,211.33
|
| Rate for Payer: United Healthcare All Payer |
$3,860.38
|
|
|
MOD SEDAT ENDO SERVICE >5YRS
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS G0500
|
| Hospital Charge Code |
37000255
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.10
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
|
|
MOD SEDAT ENDO SERVICE >5YRS
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS G0500
|
| Hospital Charge Code |
37000255
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
MOD SEDAT ENDO SERVICE >5YRS
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS G0500
|
| Hospital Charge Code |
37000255
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$36.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.80
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
MOD SEDATION EA ADDL 15 MIN
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
37000174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Anthem Medicaid |
$8.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$285.00
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$14.86
|
| Rate for Payer: Humana Medicaid |
$8.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.20
|
| Rate for Payer: Molina Healthcare Passport |
$8.04
|
| Rate for Payer: Multiplan PHCS |
$171.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$199.50
|
| Rate for Payer: UHCCP Medicaid |
$99.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.12
|
|
|
MOD SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
37000174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Humana KY Medicaid |
$98.01
|
| Rate for Payer: Kentucky WC Medicaid |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem Medicaid |
$98.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
MOD SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
37000174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
MOD SEDATION EA ADDL 15 MIN(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
370P0174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Molina Healthcare Passport |
$8.04
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Anthem Medicaid |
$8.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$14.86
|
| Rate for Payer: Humana Medicaid |
$8.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.12
|
|
|
MOD SEDATION EA ADDL 15 MIN(T
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
370T0174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
MOD SEDATION EA ADDL 15 MIN(T
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
370T0174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.60
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
MOD SED OTHER PHYS/QHP EA
|
Facility
|
OP
|
$396.10
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
37000178
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$51.49 |
| Max. Negotiated Rate |
$380.26 |
| Rate for Payer: Aetna Commercial |
$305.00
|
| Rate for Payer: Anthem Medicaid |
$136.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.96
|
| Rate for Payer: Cash Price |
$198.05
|
| Rate for Payer: Cigna Commercial |
$328.76
|
| Rate for Payer: First Health Commercial |
$376.30
|
| Rate for Payer: Humana Commercial |
$336.68
|
| Rate for Payer: Humana KY Medicaid |
$136.22
|
| Rate for Payer: Kentucky WC Medicaid |
$137.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$324.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$138.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$348.57
|
| Rate for Payer: Ohio Health Group HMO |
$297.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.79
|
| Rate for Payer: PHCS Commercial |
$380.26
|
| Rate for Payer: United Healthcare All Payer |
$348.57
|
|
|
MOD SED OTHER PHYS/QHP EA
|
Professional
|
Both
|
$396.10
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
37000178
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$46.74 |
| Max. Negotiated Rate |
$396.10 |
| Rate for Payer: Molina Healthcare Passport |
$46.74
|
| Rate for Payer: Multiplan PHCS |
$237.66
|
| Rate for Payer: Anthem Medicaid |
$46.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$396.10
|
| Rate for Payer: Cash Price |
$198.05
|
| Rate for Payer: Cash Price |
$198.05
|
| Rate for Payer: Cigna Commercial |
$82.44
|
| Rate for Payer: Humana Medicaid |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.67
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$277.27
|
| Rate for Payer: UHCCP Medicaid |
$138.64
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.21
|
|
|
MOD SED OTHER PHYS/QHP EA
|
Facility
|
IP
|
$396.10
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
37000178
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$51.49 |
| Max. Negotiated Rate |
$380.26 |
| Rate for Payer: Aetna Commercial |
$305.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$308.96
|
| Rate for Payer: Cash Price |
$198.05
|
| Rate for Payer: Cigna Commercial |
$328.76
|
| Rate for Payer: First Health Commercial |
$376.30
|
| Rate for Payer: Humana Commercial |
$336.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$324.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$292.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$118.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$348.57
|
| Rate for Payer: Ohio Health Group HMO |
$297.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$51.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$122.79
|
| Rate for Payer: PHCS Commercial |
$380.26
|
| Rate for Payer: United Healthcare All Payer |
$348.57
|
|
|
MOD SED OTHER PHYS/QHP EA(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
370P0178
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$46.74 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Anthem Medicaid |
$46.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$82.44
|
| Rate for Payer: Humana Medicaid |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.67
|
| Rate for Payer: Molina Healthcare Passport |
$46.74
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.21
|
|
|
MOD SED OTHER PHYS/QHP EA(T
|
Facility
|
OP
|
$171.10
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
370T0178
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$164.26 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Anthem Medicaid |
$58.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.46
|
| Rate for Payer: Cash Price |
$85.55
|
| Rate for Payer: Cigna Commercial |
$142.01
|
| Rate for Payer: First Health Commercial |
$162.54
|
| Rate for Payer: Humana Commercial |
$145.44
|
| Rate for Payer: Humana KY Medicaid |
$58.84
|
| Rate for Payer: Kentucky WC Medicaid |
$59.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.57
|
| Rate for Payer: Ohio Health Group HMO |
$128.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.04
|
| Rate for Payer: PHCS Commercial |
$164.26
|
| Rate for Payer: United Healthcare All Payer |
$150.57
|
|
|
MOD SED OTHER PHYS/QHP EA(T
|
Facility
|
IP
|
$171.10
|
|
|
Service Code
|
HCPCS 99157
|
| Hospital Charge Code |
370T0178
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$22.24 |
| Max. Negotiated Rate |
$164.26 |
| Rate for Payer: Aetna Commercial |
$131.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.46
|
| Rate for Payer: Cash Price |
$85.55
|
| Rate for Payer: Cigna Commercial |
$142.01
|
| Rate for Payer: First Health Commercial |
$162.54
|
| Rate for Payer: Humana Commercial |
$145.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.57
|
| Rate for Payer: Ohio Health Group HMO |
$128.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.04
|
| Rate for Payer: PHCS Commercial |
$164.26
|
| Rate for Payer: United Healthcare All Payer |
$150.57
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Professional
|
Both
|
$558.78
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
37000177
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$558.78 |
| Rate for Payer: Anthem Medicaid |
$61.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$558.78
|
| Rate for Payer: Cash Price |
$279.39
|
| Rate for Payer: Cash Price |
$279.39
|
| Rate for Payer: Cigna Commercial |
$108.76
|
| Rate for Payer: Humana Medicaid |
$61.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.87
|
| Rate for Payer: Molina Healthcare Passport |
$61.64
|
| Rate for Payer: Multiplan PHCS |
$335.27
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$391.15
|
| Rate for Payer: UHCCP Medicaid |
$195.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.26
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
OP
|
$558.78
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
37000177
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$72.64 |
| Max. Negotiated Rate |
$536.43 |
| Rate for Payer: Aetna Commercial |
$430.26
|
| Rate for Payer: Anthem Medicaid |
$192.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.85
|
| Rate for Payer: Cash Price |
$279.39
|
| Rate for Payer: Cigna Commercial |
$463.79
|
| Rate for Payer: First Health Commercial |
$530.84
|
| Rate for Payer: Humana Commercial |
$474.96
|
| Rate for Payer: Humana KY Medicaid |
$192.16
|
| Rate for Payer: Kentucky WC Medicaid |
$194.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.73
|
| Rate for Payer: Ohio Health Group HMO |
$419.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.22
|
| Rate for Payer: PHCS Commercial |
$536.43
|
| Rate for Payer: United Healthcare All Payer |
$491.73
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS
|
Facility
|
IP
|
$558.78
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
37000177
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$72.64 |
| Max. Negotiated Rate |
$536.43 |
| Rate for Payer: Aetna Commercial |
$430.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.85
|
| Rate for Payer: Cash Price |
$279.39
|
| Rate for Payer: Cigna Commercial |
$463.79
|
| Rate for Payer: First Health Commercial |
$530.84
|
| Rate for Payer: Humana Commercial |
$474.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$458.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$412.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.73
|
| Rate for Payer: Ohio Health Group HMO |
$419.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.22
|
| Rate for Payer: PHCS Commercial |
$536.43
|
| Rate for Payer: United Healthcare All Payer |
$491.73
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
370P0177
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Anthem Medicaid |
$61.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$108.76
|
| Rate for Payer: Humana Medicaid |
$61.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$96.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.87
|
| Rate for Payer: Molina Healthcare Passport |
$61.64
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.26
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS(T
|
Facility
|
OP
|
$308.78
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
370T0177
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$296.43 |
| Rate for Payer: Anthem Medicaid |
$106.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$240.85
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cigna Commercial |
$256.29
|
| Rate for Payer: First Health Commercial |
$293.34
|
| Rate for Payer: Humana Commercial |
$262.46
|
| Rate for Payer: Humana KY Medicaid |
$106.19
|
| Rate for Payer: Kentucky WC Medicaid |
$107.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.20
|
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$227.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.73
|
| Rate for Payer: Ohio Health Group HMO |
$231.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.72
|
| Rate for Payer: PHCS Commercial |
$296.43
|
| Rate for Payer: United Healthcare All Payer |
$271.73
|
|
|
MOD SED OTH PHYS/QHP 5/>YRS(T
|
Facility
|
IP
|
$308.78
|
|
|
Service Code
|
HCPCS 99156
|
| Hospital Charge Code |
370T0177
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$296.43 |
| Rate for Payer: Aetna Commercial |
$237.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$240.85
|
| Rate for Payer: Cash Price |
$154.39
|
| Rate for Payer: Cigna Commercial |
$256.29
|
| Rate for Payer: First Health Commercial |
$293.34
|
| Rate for Payer: Humana Commercial |
$262.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$253.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$227.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$271.73
|
| Rate for Payer: Ohio Health Group HMO |
$231.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.72
|
| Rate for Payer: PHCS Commercial |
$296.43
|
| Rate for Payer: United Healthcare All Payer |
$271.73
|
|
|
MOD TAP FEM PORUS 11.X142
|
Facility
|
OP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem Medicaid |
$7,680.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Humana KY Medicaid |
$7,680.87
|
| Rate for Payer: Kentucky WC Medicaid |
$7,759.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,834.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
|
MOD TAP FEM PORUS 11.X142
|
Facility
|
IP
|
$22,334.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,903.50 |
| Max. Negotiated Rate |
$21,441.22 |
| Rate for Payer: Aetna Commercial |
$17,197.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,420.99
|
| Rate for Payer: Cash Price |
$11,167.30
|
| Rate for Payer: Cigna Commercial |
$18,537.72
|
| Rate for Payer: First Health Commercial |
$21,217.87
|
| Rate for Payer: Humana Commercial |
$18,984.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,314.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,482.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,700.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,654.45
|
| Rate for Payer: Ohio Health Group HMO |
$16,750.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,466.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,923.73
|
| Rate for Payer: PHCS Commercial |
$21,441.22
|
| Rate for Payer: United Healthcare All Payer |
$19,654.45
|
|
