|
MR SAFETY IMPLANT ELEC PREPJ(T
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
HCPCS 76018
|
| Hospital Charge Code |
610T0093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$50.70 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.61
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
MR SAFETY IMPLANT ELEC PREPJ(T
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
HCPCS 76018
|
| Hospital Charge Code |
610T0093
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$162.24 |
| Rate for Payer: Aetna Commercial |
$130.13
|
| Rate for Payer: Anthem Medicaid |
$58.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$84.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.49
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cash Price |
$84.50
|
| Rate for Payer: Cigna Commercial |
$140.27
|
| Rate for Payer: First Health Commercial |
$160.55
|
| Rate for Payer: Humana Commercial |
$143.65
|
| Rate for Payer: Humana KY Medicaid |
$58.12
|
| Rate for Payer: Humana Medicare Advantage |
$84.81
|
| Rate for Payer: Kentucky WC Medicaid |
$58.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.72
|
| Rate for Payer: Ohio Health Group HMO |
$126.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.61
|
| Rate for Payer: PHCS Commercial |
$162.24
|
| Rate for Payer: United Healthcare All Payer |
$148.72
|
|
|
MR SAFETY IMPLT POS&/IMMOBLJ
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 76019
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
MR SAFETY IMPLT POS&/IMMOBLJ
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 76019
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$174.94 |
| Rate for Payer: Ambetter Exchange |
$134.57
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$134.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$134.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.48
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Humana Medicaid |
$118.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$134.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.02
|
| Rate for Payer: Molina Healthcare Passport |
$118.65
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$174.94
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$134.57
|
|
|
MR SAFETY IMPLT POS&/IMMOBLJ
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 76019
|
| Hospital Charge Code |
61000094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
MR SAFETY IMPLT POS&/IMMOBLJ(P
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 76019
|
| Hospital Charge Code |
610P0094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$174.94 |
| Rate for Payer: Ambetter Exchange |
$134.57
|
| Rate for Payer: Anthem Medicaid |
$118.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$134.57
|
| Rate for Payer: Buckeye Medicare Advantage |
$134.57
|
| Rate for Payer: CareSource Just4Me Medicare |
$161.48
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Cash Price |
$32.50
|
| Rate for Payer: Humana Medicaid |
$118.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$134.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$121.02
|
| Rate for Payer: Molina Healthcare Passport |
$118.65
|
| Rate for Payer: Multiplan PHCS |
$39.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$174.94
|
| Rate for Payer: UHCCP Medicaid |
$22.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$119.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$134.57
|
|
|
MR SAFETY IMPLT POS&/IMMOBLJ(T
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 76019
|
| Hospital Charge Code |
610T0094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.80
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.90
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
|
MR SAFETY IMPLT POS&/IMMOBLJ(T
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS 76019
|
| Hospital Charge Code |
610T0094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$105.60 |
| Rate for Payer: Aetna Commercial |
$84.70
|
| Rate for Payer: Anthem Medicaid |
$37.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cash Price |
$55.00
|
| Rate for Payer: Cigna Commercial |
$91.30
|
| Rate for Payer: First Health Commercial |
$104.50
|
| Rate for Payer: Humana Commercial |
$93.50
|
| Rate for Payer: Humana KY Medicaid |
$37.83
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$38.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$96.80
|
| Rate for Payer: Ohio Health Group HMO |
$82.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.90
|
| Rate for Payer: PHCS Commercial |
$105.60
|
| Rate for Payer: United Healthcare All Payer |
$96.80
|
|
|
MRSA PCR
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
30002025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$130.80 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$130.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$76.30
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
MRSA PCR
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
30002025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
MRSA PCR
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS 87641
|
| Hospital Charge Code |
30002025
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$209.28 |
| Rate for Payer: Aetna Commercial |
$167.86
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cash Price |
$109.00
|
| Rate for Payer: Cigna Commercial |
$180.94
|
| Rate for Payer: First Health Commercial |
$207.10
|
| Rate for Payer: Humana Commercial |
$185.30
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$178.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$160.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$191.84
|
| Rate for Payer: Ohio Health Group HMO |
$163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$150.42
|
| Rate for Payer: PHCS Commercial |
$209.28
|
| Rate for Payer: United Healthcare All Payer |
$191.84
|
|
|
MRS CEM STEM STR 13*127MM
|
Facility
|
IP
|
$18,686.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,605.93 |
| Max. Negotiated Rate |
$17,938.98 |
| Rate for Payer: Aetna Commercial |
$14,388.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,575.42
|
| Rate for Payer: Cash Price |
$9,343.22
|
| Rate for Payer: Cigna Commercial |
$15,509.75
|
| Rate for Payer: First Health Commercial |
$17,752.12
|
| Rate for Payer: Humana Commercial |
$15,883.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,322.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,790.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,605.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,444.07
|
| Rate for Payer: Ohio Health Group HMO |
$14,014.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,949.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,257.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,893.64
|
| Rate for Payer: PHCS Commercial |
$17,938.98
|
| Rate for Payer: United Healthcare All Payer |
$16,444.07
|
|
|
MRS CEM STEM STR 13*127MM
|
Facility
|
OP
|
$18,686.44
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,605.93 |
| Max. Negotiated Rate |
$17,938.98 |
| Rate for Payer: Aetna Commercial |
$14,388.56
|
| Rate for Payer: Anthem Medicaid |
$6,426.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,575.42
|
| Rate for Payer: Cash Price |
$9,343.22
|
| Rate for Payer: Cigna Commercial |
$15,509.75
|
| Rate for Payer: First Health Commercial |
$17,752.12
|
| Rate for Payer: Humana Commercial |
$15,883.47
|
| Rate for Payer: Humana KY Medicaid |
$6,426.27
|
| Rate for Payer: Kentucky WC Medicaid |
$6,491.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,322.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,790.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,605.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,555.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,444.07
|
| Rate for Payer: Ohio Health Group HMO |
$14,014.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,949.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,257.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,893.64
|
| Rate for Payer: PHCS Commercial |
$17,938.98
|
| Rate for Payer: United Healthcare All Payer |
$16,444.07
|
|
|
MR SFTY IMPLT&/FB ASMT STF 1
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
HCPCS 76014
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem Medicaid |
$17.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Humana KY Medicaid |
$17.54
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$17.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
MR SFTY IMPLT&/FB ASMT STF 1
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
HCPCS 76014
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$48.96 |
| Rate for Payer: Aetna Commercial |
$39.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.78
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$42.33
|
| Rate for Payer: First Health Commercial |
$48.45
|
| Rate for Payer: Humana Commercial |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$37.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.88
|
| Rate for Payer: Ohio Health Group HMO |
$38.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.19
|
| Rate for Payer: PHCS Commercial |
$48.96
|
| Rate for Payer: United Healthcare All Payer |
$44.88
|
|
|
MR SFTY IMPLT&/FB ASMT STF 1
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 76014
|
| Hospital Charge Code |
61000089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$8.60 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Ambetter Exchange |
$9.76
|
| Rate for Payer: Anthem Medicaid |
$8.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.71
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Humana Medicaid |
$8.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$8.77
|
| Rate for Payer: Molina Healthcare Passport |
$8.60
|
| Rate for Payer: Multiplan PHCS |
$30.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.69
|
| Rate for Payer: UHCCP Medicaid |
$17.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$8.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.76
|
|
|
MR SFTY MED PHYSICS XM CSTMZ
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 76017
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$188.46 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MR SFTY MED PHYSICS XM CSTMZ
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 76017
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$178.69 |
| Max. Negotiated Rate |
$328.80 |
| Rate for Payer: Ambetter Exchange |
$202.71
|
| Rate for Payer: Anthem Medicaid |
$178.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.25
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Humana Medicaid |
$178.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.26
|
| Rate for Payer: Molina Healthcare Passport |
$178.69
|
| Rate for Payer: Multiplan PHCS |
$328.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$263.52
|
| Rate for Payer: UHCCP Medicaid |
$191.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.71
|
|
|
MR SFTY MED PHYSICS XM CSTMZ
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 76017
|
| Hospital Charge Code |
61000092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$164.40 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$378.12
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
MR SFTY MED PHYSICS XM CSTMZ(P
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 76017
|
| Hospital Charge Code |
610P0092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$263.52 |
| Rate for Payer: Ambetter Exchange |
$202.71
|
| Rate for Payer: Anthem Medicaid |
$178.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$202.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$202.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$243.25
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Humana Medicaid |
$178.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$202.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.26
|
| Rate for Payer: Molina Healthcare Passport |
$178.69
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$263.52
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$180.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$202.71
|
|
|
MR SFTY MED PHYSICS XM CSTMZ(T
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
HCPCS 76017
|
| Hospital Charge Code |
610T0092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$157.51 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem Medicaid |
$157.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Humana KY Medicaid |
$157.51
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$159.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
MR SFTY MED PHYSICS XM CSTMZ(T
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
HCPCS 76017
|
| Hospital Charge Code |
610T0092
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$439.68 |
| Rate for Payer: Aetna Commercial |
$352.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$357.24
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cigna Commercial |
$380.14
|
| Rate for Payer: First Health Commercial |
$435.10
|
| Rate for Payer: Humana Commercial |
$389.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$338.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$403.04
|
| Rate for Payer: Ohio Health Group HMO |
$343.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$398.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$316.02
|
| Rate for Payer: PHCS Commercial |
$439.68
|
| Rate for Payer: United Healthcare All Payer |
$403.04
|
|
|
MR SFTY MPLT&/FB ASMT STF EA
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS 76015
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
|
MR SFTY MPLT&/FB ASMT STF EA
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 76015
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$61.16 |
| Rate for Payer: Ambetter Exchange |
$47.05
|
| Rate for Payer: Anthem Medicaid |
$41.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$47.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$47.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$56.46
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Humana Medicaid |
$41.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$47.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.26
|
| Rate for Payer: Molina Healthcare Passport |
$41.43
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$61.16
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$47.05
|
|
|
MR SFTY MPLT&/FB ASMT STF EA
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS 76015
|
| Hospital Charge Code |
61000090
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$38.50
|
| Rate for Payer: Anthem Medicaid |
$17.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$39.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$41.50
|
| Rate for Payer: First Health Commercial |
$47.50
|
| Rate for Payer: Humana Commercial |
$42.50
|
| Rate for Payer: Humana KY Medicaid |
$17.20
|
| Rate for Payer: Kentucky WC Medicaid |
$17.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$41.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$36.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$44.00
|
| Rate for Payer: Ohio Health Group HMO |
$37.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.50
|
| Rate for Payer: PHCS Commercial |
$48.00
|
| Rate for Payer: United Healthcare All Payer |
$44.00
|
|
