|
OMENTECOMTY W/BSO
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58950
|
| Hospital Charge Code |
76102264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$773.05 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,615.85
|
| Rate for Payer: Anthem Medicaid |
$773.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,573.36
|
| Rate for Payer: Healthspan PPO |
$1,564.55
|
| Rate for Payer: Humana Medicaid |
$773.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,399.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$788.51
|
| Rate for Payer: Molina Healthcare Passport |
$773.05
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$780.78
|
|
|
OMENTECOMTY W/BSO
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58950
|
| Hospital Charge Code |
76102264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$1,925.00
|
| Rate for Payer: Anthem Medicaid |
$859.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,950.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$2,075.00
|
| Rate for Payer: First Health Commercial |
$2,375.00
|
| Rate for Payer: Humana Commercial |
$2,125.00
|
| Rate for Payer: Humana KY Medicaid |
$859.75
|
| Rate for Payer: Kentucky WC Medicaid |
$868.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,050.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,845.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$750.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$877.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,200.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,875.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$775.00
|
| Rate for Payer: PHCS Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare All Payer |
$2,200.00
|
|
|
OMENTECOMTY W/BSO(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 58950
|
| Hospital Charge Code |
761P2264
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$773.05 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Aetna Commercial |
$1,615.85
|
| Rate for Payer: Anthem Medicaid |
$773.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$1,573.36
|
| Rate for Payer: Healthspan PPO |
$1,564.55
|
| Rate for Payer: Humana Medicaid |
$773.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,399.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$788.51
|
| Rate for Payer: Molina Healthcare Passport |
$773.05
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$875.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$780.78
|
|
|
OMENTECOMTY W/TAH & LN BX
|
Facility
|
IP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 58951
|
| Hospital Charge Code |
76102265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
OMENTECOMTY W/TAH & LN BX
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 58951
|
| Hospital Charge Code |
76102265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,184.26 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$2,086.28
|
| Rate for Payer: Anthem Medicaid |
$1,184.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,034.56
|
| Rate for Payer: Healthspan PPO |
$2,020.05
|
| Rate for Payer: Humana Medicaid |
$1,184.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,800.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,207.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,184.26
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,940.00
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,196.10
|
|
|
OMENTECOMTY W/TAH & LN BX
|
Facility
|
OP
|
$4,200.00
|
|
|
Service Code
|
HCPCS 58951
|
| Hospital Charge Code |
76102265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$4,032.00 |
| Rate for Payer: Aetna Commercial |
$3,234.00
|
| Rate for Payer: Anthem Medicaid |
$1,444.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,276.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$3,486.00
|
| Rate for Payer: First Health Commercial |
$3,990.00
|
| Rate for Payer: Humana Commercial |
$3,570.00
|
| Rate for Payer: Humana KY Medicaid |
$1,444.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,444.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,099.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,473.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,696.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.00
|
| Rate for Payer: PHCS Commercial |
$4,032.00
|
| Rate for Payer: United Healthcare All Payer |
$3,696.00
|
|
|
OMENTECOMTY W/TAH & LN BX(P
|
Professional
|
Both
|
$4,200.00
|
|
|
Service Code
|
HCPCS 58951
|
| Hospital Charge Code |
761P2265
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,184.26 |
| Max. Negotiated Rate |
$4,200.00 |
| Rate for Payer: Aetna Commercial |
$2,086.28
|
| Rate for Payer: Anthem Medicaid |
$1,184.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,200.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$2,034.56
|
| Rate for Payer: Healthspan PPO |
$2,020.05
|
| Rate for Payer: Humana Medicaid |
$1,184.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,800.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,207.95
|
| Rate for Payer: Molina Healthcare Passport |
$1,184.26
|
| Rate for Payer: Multiplan PHCS |
$2,520.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,940.00
|
| Rate for Payer: UHCCP Medicaid |
$1,470.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,196.10
|
|
|
OMENTECTOMY
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49255
|
| Hospital Charge Code |
76101986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OMENTECTOMY
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49255
|
| Hospital Charge Code |
76101986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.89 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,126.51
|
| Rate for Payer: Anthem Medicaid |
$284.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,049.27
|
| Rate for Payer: Healthspan PPO |
$950.01
|
| Rate for Payer: Humana Medicaid |
$284.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.59
|
| Rate for Payer: Molina Healthcare Passport |
$284.89
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.74
|
|
|
OMENTECTOMY
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49255
|
| Hospital Charge Code |
76101986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
OMENTECTOMY(P
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 49255
|
| Hospital Charge Code |
761P1986
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$284.89 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$1,126.51
|
| Rate for Payer: Anthem Medicaid |
$284.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,200.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,049.27
|
| Rate for Payer: Healthspan PPO |
$950.01
|
| Rate for Payer: Humana Medicaid |
$284.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,001.94
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$290.59
|
| Rate for Payer: Molina Healthcare Passport |
$284.89
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$840.00
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$287.74
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
76102508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
OMM 5-6 BODY REGIONS
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
76102508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna Commercial |
$42.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$36.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$167.00
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Humana Medicaid |
$36.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.18
|
| Rate for Payer: Molina Healthcare Passport |
$36.45
|
| Rate for Payer: Multiplan PHCS |
$100.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.90
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.81
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
76102508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$57.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Humana KY Medicaid |
$57.43
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$58.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
45000316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem Medicaid |
$18.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Humana KY Medicaid |
$18.23
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$18.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OMM 5-6 BODY REGIONS
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
45000316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$40.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$41.34
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$43.99
|
| Rate for Payer: First Health Commercial |
$50.35
|
| Rate for Payer: Humana Commercial |
$45.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$43.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$39.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$46.64
|
| Rate for Payer: Ohio Health Group HMO |
$39.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16.43
|
| Rate for Payer: PHCS Commercial |
$50.88
|
| Rate for Payer: United Healthcare All Payer |
$46.64
|
|
|
OMM 5-6 BODY REGIONS(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
761P2508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$42.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$23.53
|
| Rate for Payer: Anthem Medicaid |
$36.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$68.27
|
| Rate for Payer: Humana Medicaid |
$36.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$54.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.18
|
| Rate for Payer: Molina Healthcare Passport |
$36.45
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.81
|
|
|
OMM 5-6 BODY REGIONS(T
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
761T2508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$23.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$23.04
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$23.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
OMM 5-6 BODY REGIONS(T
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 98927
|
| Hospital Charge Code |
761T2508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.77
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
OMM 7-8 BODY REGIONS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
76102509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$80.89 |
| Rate for Payer: Aetna Commercial |
$50.59
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$42.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$55.00
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$80.89
|
| Rate for Payer: Humana Medicaid |
$42.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.31
|
| Rate for Payer: Molina Healthcare Passport |
$42.46
|
| Rate for Payer: Multiplan PHCS |
$33.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.50
|
| Rate for Payer: UHCCP Medicaid |
$31.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.88
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
76102509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
45000317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Humana KY Medicaid |
$19.60
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$19.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
45000317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$54.72 |
| Rate for Payer: Aetna Commercial |
$43.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$44.46
|
| Rate for Payer: Cash Price |
$28.50
|
| Rate for Payer: Cigna Commercial |
$47.31
|
| Rate for Payer: First Health Commercial |
$54.15
|
| Rate for Payer: Humana Commercial |
$48.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$46.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$50.16
|
| Rate for Payer: Ohio Health Group HMO |
$42.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.67
|
| Rate for Payer: PHCS Commercial |
$54.72
|
| Rate for Payer: United Healthcare All Payer |
$50.16
|
|
|
OMM 7-8 BODY REGIONS
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
HCPCS 98928
|
| Hospital Charge Code |
76102509
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$52.80 |
| Rate for Payer: Aetna Commercial |
$42.35
|
| Rate for Payer: Anthem Medicaid |
$18.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$42.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.42
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.29
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cigna Commercial |
$45.65
|
| Rate for Payer: First Health Commercial |
$52.25
|
| Rate for Payer: Humana Commercial |
$46.75
|
| Rate for Payer: Humana KY Medicaid |
$18.91
|
| Rate for Payer: Humana Medicare Advantage |
$22.44
|
| Rate for Payer: Kentucky WC Medicaid |
$19.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$45.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$40.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$48.40
|
| Rate for Payer: Ohio Health Group HMO |
$41.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.05
|
| Rate for Payer: PHCS Commercial |
$52.80
|
| Rate for Payer: United Healthcare All Payer |
$48.40
|
|
|
OMM 9-10 BODY REGIONS
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 98929
|
| Hospital Charge Code |
76102510
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$7.54 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.98
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
