|
MOD ROT HINGE KNEE FEM 10MM XL
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD ROT HINGE KNEE FEM 10MM XS
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem Medicaid |
$1,493.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Humana KY Medicaid |
$1,493.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD ROT HINGE KNEE FEM 10MM XS
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD ROT HINGE KNE FEM 10MM LRG
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem Medicaid |
$1,493.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Humana KY Medicaid |
$1,493.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD ROT HINGE KNE FEM 10MM LRG
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD ROT HINGE KNE FEM 10MM MED
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem Medicaid |
$1,493.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Humana KY Medicaid |
$1,493.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD ROT HINGE KNE FEM 10MM MED
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,302.90 |
| Max. Negotiated Rate |
$4,169.28 |
| Rate for Payer: Aetna Commercial |
$3,344.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,387.54
|
| Rate for Payer: Cash Price |
$2,171.50
|
| Rate for Payer: Cigna Commercial |
$3,604.69
|
| Rate for Payer: First Health Commercial |
$4,125.85
|
| Rate for Payer: Humana Commercial |
$3,691.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,561.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,205.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,821.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,474.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,778.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,996.67
|
| Rate for Payer: PHCS Commercial |
$4,169.28
|
| Rate for Payer: United Healthcare All Payer |
$3,821.84
|
|
|
MOD SEDAT ENDO SERVICE >5YRS
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS G0500
|
| Hospital Charge Code |
37000255
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$54.00 |
| 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 |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| 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 |
$54.00 |
| 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 |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
MOD SEDAT ENDO SERVICE >5YRS
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS G0500
|
| Hospital Charge Code |
37000255
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Ambetter Exchange |
$5.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$5.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$5.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$5.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.42
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7.05
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$5.42
|
|
|
MOD SEDATION EA ADDL 15 MIN
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
37000174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Ambetter Exchange |
$10.69
|
| Rate for Payer: Anthem Medicaid |
$8.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.83
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.20
|
| Rate for Payer: Molina Healthcare Passport |
$8.04
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.90
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.69
|
|
|
MOD SEDATION EA ADDL 15 MIN
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
37000174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
MOD SEDATION EA ADDL 15 MIN
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
37000174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
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 |
$78.00 |
| Rate for Payer: Ambetter Exchange |
$10.69
|
| Rate for Payer: Anthem Medicaid |
$8.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$10.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$10.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$10.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.20
|
| Rate for Payer: Molina Healthcare Passport |
$8.04
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13.90
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$10.69
|
|
|
MOD SEDATION EA ADDL 15 MIN(T
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
370T0174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem Medicaid |
$58.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.60
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Humana KY Medicaid |
$58.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
MOD SEDATION EA ADDL 15 MIN(T
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 99153
|
| Hospital Charge Code |
370T0174
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Aetna Commercial |
$130.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$132.60
|
| Rate for Payer: Cash Price |
$85.00
|
| Rate for Payer: Cigna Commercial |
$141.10
|
| Rate for Payer: First Health Commercial |
$161.50
|
| Rate for Payer: Humana Commercial |
$144.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$139.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$125.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$149.60
|
| Rate for Payer: Ohio Health Group HMO |
$127.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$136.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.30
|
| Rate for Payer: PHCS Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Payer |
$149.60
|
|
|
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 |
$237.66 |
| Rate for Payer: Ambetter Exchange |
$54.50
|
| Rate for Payer: Anthem Medicaid |
$46.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$54.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.67
|
| Rate for Payer: Molina Healthcare Passport |
$46.74
|
| Rate for Payer: Multiplan PHCS |
$237.66
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.85
|
| Rate for Payer: UHCCP Medicaid |
$138.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.50
|
|
|
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 |
$118.83 |
| 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 |
$336.69
|
| 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 |
$297.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.31
|
| Rate for Payer: PHCS Commercial |
$380.26
|
| Rate for Payer: United Healthcare All Payer |
$348.57
|
|
|
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 |
$118.83 |
| 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 |
$336.69
|
| 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 |
$297.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$344.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$273.31
|
| 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 |
$135.00 |
| Rate for Payer: Ambetter Exchange |
$54.50
|
| Rate for Payer: Anthem Medicaid |
$46.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.40
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$54.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.50
|
| 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 |
$70.85
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.21
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.50
|
|
|
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 |
$51.33 |
| 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 |
$136.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.06
|
| 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 |
$51.33 |
| 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 |
$136.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.06
|
| 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 |
$335.27 |
| Rate for Payer: Ambetter Exchange |
$70.21
|
| Rate for Payer: Anthem Medicaid |
$61.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$70.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$84.25
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$70.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.21
|
| 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 |
$91.27
|
| Rate for Payer: UHCCP Medicaid |
$195.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$70.21
|
|
|
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 |
$167.63 |
| 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 |
$447.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.56
|
| Rate for Payer: PHCS Commercial |
$536.43
|
| Rate for Payer: United Healthcare All Payer |
$491.73
|
|
|
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 |
$167.63 |
| 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 |
$447.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.56
|
| Rate for Payer: PHCS Commercial |
$536.43
|
| Rate for Payer: United Healthcare All Payer |
$491.73
|
|
