OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,159.52
|
|
Service Code
|
MSDRG 804
|
Min. Negotiated Rate |
$9,608.24 |
Max. Negotiated Rate |
$14,159.52 |
Rate for Payer: Molina Healthcare Medicaid |
$9,800.41
|
Rate for Payer: Anthem Medicaid |
$9,608.24
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$10,113.94
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,159.52
|
Rate for Payer: CareSource Just4Me Medicare |
$13,653.82
|
Rate for Payer: Humana KY Medicaid |
$9,608.24
|
Rate for Payer: Humana Medicare Advantage |
$10,113.94
|
Rate for Payer: Kentucky WC Medicaid |
$9,704.33
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$12,136.73
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$21,177.25
|
|
Service Code
|
MSDRG 205
|
Min. Negotiated Rate |
$14,370.28 |
Max. Negotiated Rate |
$21,177.25 |
Rate for Payer: Anthem Medicaid |
$14,370.28
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$15,126.61
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,177.25
|
Rate for Payer: CareSource Just4Me Medicare |
$20,420.92
|
Rate for Payer: Humana KY Medicaid |
$14,370.28
|
Rate for Payer: Humana Medicare Advantage |
$15,126.61
|
Rate for Payer: Kentucky WC Medicaid |
$14,513.98
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$18,151.93
|
Rate for Payer: Molina Healthcare Medicaid |
$14,657.69
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC
|
Facility
|
IP
|
$10,686.31
|
|
Service Code
|
MSDRG 206
|
Min. Negotiated Rate |
$7,251.43 |
Max. Negotiated Rate |
$10,686.31 |
Rate for Payer: Anthem Medicaid |
$7,251.43
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$7,633.08
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$10,686.31
|
Rate for Payer: CareSource Just4Me Medicare |
$10,304.66
|
Rate for Payer: Humana KY Medicaid |
$7,251.43
|
Rate for Payer: Humana Medicare Advantage |
$7,633.08
|
Rate for Payer: Kentucky WC Medicaid |
$7,323.94
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$9,159.70
|
Rate for Payer: Molina Healthcare Medicaid |
$7,396.45
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$21,288.40
|
|
Service Code
|
MSDRG 167
|
Min. Negotiated Rate |
$14,445.70 |
Max. Negotiated Rate |
$21,288.40 |
Rate for Payer: Anthem Medicaid |
$14,445.70
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$15,206.00
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21,288.40
|
Rate for Payer: CareSource Just4Me Medicare |
$20,528.10
|
Rate for Payer: Humana KY Medicaid |
$14,445.70
|
Rate for Payer: Humana Medicare Advantage |
$15,206.00
|
Rate for Payer: Kentucky WC Medicaid |
$14,590.16
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$18,247.20
|
Rate for Payer: Molina Healthcare Medicaid |
$14,734.61
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$47,468.97
|
|
Service Code
|
MSDRG 166
|
Min. Negotiated Rate |
$32,211.09 |
Max. Negotiated Rate |
$47,468.97 |
Rate for Payer: Anthem Medicaid |
$32,211.09
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$33,906.41
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$47,468.97
|
Rate for Payer: CareSource Just4Me Medicare |
$45,773.65
|
Rate for Payer: Humana KY Medicaid |
$32,211.09
|
Rate for Payer: Humana Medicare Advantage |
$33,906.41
|
Rate for Payer: Kentucky WC Medicaid |
$32,533.20
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$40,687.69
|
Rate for Payer: Molina Healthcare Medicaid |
$32,855.31
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,859.26
|
|
Service Code
|
MSDRG 168
|
Min. Negotiated Rate |
$10,761.64 |
Max. Negotiated Rate |
$15,859.26 |
Rate for Payer: Anthem Medicaid |
$10,761.64
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$11,328.04
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,859.26
|
Rate for Payer: CareSource Just4Me Medicare |
$15,292.85
|
Rate for Payer: Humana KY Medicaid |
$10,761.64
|
Rate for Payer: Humana Medicare Advantage |
$11,328.04
|
Rate for Payer: Kentucky WC Medicaid |
$10,869.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$13,593.65
|
Rate for Payer: Molina Healthcare Medicaid |
$10,976.87
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
|
IP
|
$20,432.06
|
|
Service Code
|
MSDRG 580
|
Min. Negotiated Rate |
$13,864.61 |
Max. Negotiated Rate |
$20,432.06 |
Rate for Payer: Anthem Medicaid |
$13,864.61
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$14,594.33
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,432.06
|
Rate for Payer: CareSource Just4Me Medicare |
$19,702.35
|
Rate for Payer: Humana KY Medicaid |
$13,864.61
|
Rate for Payer: Humana Medicare Advantage |
$14,594.33
|
Rate for Payer: Kentucky WC Medicaid |
$14,003.26
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$17,513.20
|
Rate for Payer: Molina Healthcare Medicaid |
$14,141.91
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,097.76
|
|
Service Code
|
MSDRG 579
|
Min. Negotiated Rate |
$26,530.62 |
Max. Negotiated Rate |
$39,097.76 |
Rate for Payer: Anthem Medicaid |
$26,530.62
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$27,926.97
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,097.76
|
Rate for Payer: CareSource Just4Me Medicare |
$37,701.41
|
Rate for Payer: Humana KY Medicaid |
$26,530.62
|
Rate for Payer: Humana Medicare Advantage |
$27,926.97
|
Rate for Payer: Kentucky WC Medicaid |
$26,795.93
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$33,512.36
|
Rate for Payer: Molina Healthcare Medicaid |
$27,061.23
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,753.96
|
|
Service Code
|
MSDRG 581
|
Min. Negotiated Rate |
$10,690.19 |
Max. Negotiated Rate |
$15,753.96 |
Rate for Payer: Anthem Medicaid |
$10,690.19
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$11,252.83
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,753.96
|
Rate for Payer: CareSource Just4Me Medicare |
$15,191.32
|
Rate for Payer: Humana KY Medicaid |
$10,690.19
|
Rate for Payer: Humana Medicare Advantage |
$11,252.83
|
Rate for Payer: Kentucky WC Medicaid |
$10,797.09
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$13,503.40
|
Rate for Payer: Molina Healthcare Medicaid |
$10,903.99
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$29,843.28
|
|
Service Code
|
MSDRG 253
|
Min. Negotiated Rate |
$20,250.80 |
Max. Negotiated Rate |
$29,843.28 |
Rate for Payer: Anthem Medicaid |
$20,250.80
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$21,316.63
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$29,843.28
|
Rate for Payer: CareSource Just4Me Medicare |
$28,777.45
|
Rate for Payer: Humana KY Medicaid |
$20,250.80
|
Rate for Payer: Humana Medicare Advantage |
$21,316.63
|
Rate for Payer: Kentucky WC Medicaid |
$20,453.31
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$25,579.96
|
Rate for Payer: Molina Healthcare Medicaid |
$20,655.81
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,233.45
|
|
Service Code
|
MSDRG 252
|
Min. Negotiated Rate |
$26,622.70 |
Max. Negotiated Rate |
$39,233.45 |
Rate for Payer: Anthem Medicaid |
$26,622.70
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$28,023.89
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$39,233.45
|
Rate for Payer: CareSource Just4Me Medicare |
$37,832.25
|
Rate for Payer: Humana KY Medicaid |
$26,622.70
|
Rate for Payer: Humana Medicare Advantage |
$28,023.89
|
Rate for Payer: Kentucky WC Medicaid |
$26,888.92
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$33,628.67
|
Rate for Payer: Molina Healthcare Medicaid |
$27,155.15
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,297.56
|
|
Service Code
|
MSDRG 254
|
Min. Negotiated Rate |
$13,773.35 |
Max. Negotiated Rate |
$20,297.56 |
Rate for Payer: Anthem Medicaid |
$13,773.35
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$14,498.26
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20,297.56
|
Rate for Payer: CareSource Just4Me Medicare |
$19,572.65
|
Rate for Payer: Humana KY Medicaid |
$13,773.35
|
Rate for Payer: Humana Medicare Advantage |
$14,498.26
|
Rate for Payer: Kentucky WC Medicaid |
$13,911.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$17,397.91
|
Rate for Payer: Molina Healthcare Medicaid |
$14,048.81
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$13,899.80
|
|
Service Code
|
MSDRG 152
|
Min. Negotiated Rate |
$9,432.01 |
Max. Negotiated Rate |
$13,899.80 |
Rate for Payer: Anthem Medicaid |
$9,432.01
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$9,928.43
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,899.80
|
Rate for Payer: CareSource Just4Me Medicare |
$13,403.38
|
Rate for Payer: Humana KY Medicaid |
$9,432.01
|
Rate for Payer: Humana Medicare Advantage |
$9,928.43
|
Rate for Payer: Kentucky WC Medicaid |
$9,526.33
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$11,914.12
|
Rate for Payer: Molina Healthcare Medicaid |
$9,620.65
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$8,595.85
|
|
Service Code
|
MSDRG 153
|
Min. Negotiated Rate |
$5,832.90 |
Max. Negotiated Rate |
$8,595.85 |
Rate for Payer: Anthem Medicaid |
$5,832.90
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$6,139.89
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,595.85
|
Rate for Payer: CareSource Just4Me Medicare |
$8,288.85
|
Rate for Payer: Humana KY Medicaid |
$5,832.90
|
Rate for Payer: Humana Medicare Advantage |
$6,139.89
|
Rate for Payer: Kentucky WC Medicaid |
$5,891.22
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$7,367.87
|
Rate for Payer: Molina Healthcare Medicaid |
$5,949.55
|
|
OTOLARYNGOLOGIC EXAM
|
Facility
|
IP
|
$3,283.57
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
76102449
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$426.86 |
Max. Negotiated Rate |
$3,152.23 |
Rate for Payer: Aetna Commercial |
$2,528.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.18
|
Rate for Payer: Cash Price |
$1,641.79
|
Rate for Payer: Cigna Commercial |
$2,725.36
|
Rate for Payer: First Health Commercial |
$3,119.39
|
Rate for Payer: Humana Commercial |
$2,791.03
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$985.07
|
Rate for Payer: Ohio Health Choice Commercial |
$2,889.54
|
Rate for Payer: Ohio Health Group HMO |
$2,462.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$656.71
|
Rate for Payer: Ohio Health Group PPO No Differential |
$426.86
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.91
|
Rate for Payer: PHCS Commercial |
$3,152.23
|
Rate for Payer: United Healthcare All Payer |
$2,889.54
|
|
OTOLARYNGOLOGIC EXAM
|
Facility
|
OP
|
$3,283.57
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
76102449
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$426.86 |
Max. Negotiated Rate |
$3,152.23 |
Rate for Payer: Aetna Commercial |
$2,528.35
|
Rate for Payer: Anthem Medicaid |
$1,129.22
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.18
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
Rate for Payer: Cash Price |
$1,641.79
|
Rate for Payer: Cash Price |
$1,641.79
|
Rate for Payer: Cigna Commercial |
$2,725.36
|
Rate for Payer: First Health Commercial |
$3,119.39
|
Rate for Payer: Humana Commercial |
$2,791.03
|
Rate for Payer: Humana KY Medicaid |
$1,129.22
|
Rate for Payer: Humana Medicare Advantage |
$475.79
|
Rate for Payer: Kentucky WC Medicaid |
$1,140.71
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.27
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
Rate for Payer: Molina Healthcare Medicaid |
$1,151.88
|
Rate for Payer: Ohio Health Choice Commercial |
$2,889.54
|
Rate for Payer: Ohio Health Group HMO |
$2,462.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$656.71
|
Rate for Payer: Ohio Health Group PPO No Differential |
$426.86
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.91
|
Rate for Payer: PHCS Commercial |
$3,152.23
|
Rate for Payer: United Healthcare All Payer |
$2,889.54
|
|
OTOLARYNGOLOGIC EXAM
|
Professional
|
Both
|
$3,283.57
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
76102449
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$77.27 |
Max. Negotiated Rate |
$3,283.57 |
Rate for Payer: Aetna Commercial |
$121.26
|
Rate for Payer: Anthem Medicaid |
$77.27
|
Rate for Payer: Buckeye Medicare Advantage |
$3,283.57
|
Rate for Payer: Cash Price |
$1,641.79
|
Rate for Payer: Cash Price |
$1,641.79
|
Rate for Payer: Cigna Commercial |
$143.58
|
Rate for Payer: Healthspan PPO |
$116.73
|
Rate for Payer: Humana Medicaid |
$77.27
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.64
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.82
|
Rate for Payer: Molina Healthcare Passport |
$77.27
|
Rate for Payer: Multiplan PHCS |
$1,970.14
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,298.50
|
Rate for Payer: UHCCP Medicaid |
$1,149.25
|
Rate for Payer: Wellcare CHIP/Medicaid |
$78.04
|
|
OTOLARYNGOLOGIC EXAM(P
|
Professional
|
Both
|
$300.00
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
761P2449
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$77.27 |
Max. Negotiated Rate |
$300.00 |
Rate for Payer: Aetna Commercial |
$121.26
|
Rate for Payer: Anthem Medicaid |
$77.27
|
Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
Rate for Payer: Cash Price |
$150.00
|
Rate for Payer: Cash Price |
$150.00
|
Rate for Payer: Cigna Commercial |
$143.58
|
Rate for Payer: Healthspan PPO |
$116.73
|
Rate for Payer: Humana Medicaid |
$77.27
|
Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.64
|
Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.82
|
Rate for Payer: Molina Healthcare Passport |
$77.27
|
Rate for Payer: Multiplan PHCS |
$180.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
Rate for Payer: UHCCP Medicaid |
$105.00
|
Rate for Payer: Wellcare CHIP/Medicaid |
$78.04
|
|
OTOLARYNGOLOGIC EXAM(T
|
Facility
|
OP
|
$2,983.57
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
761T2449
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$387.86 |
Max. Negotiated Rate |
$2,864.23 |
Rate for Payer: Aetna Commercial |
$2,297.35
|
Rate for Payer: Anthem Medicaid |
$1,026.05
|
Rate for Payer: Anthem Medicare Advantage/PPO |
$475.79
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,327.18
|
Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$666.11
|
Rate for Payer: CareSource Just4Me Medicare |
$642.32
|
Rate for Payer: Cash Price |
$1,491.79
|
Rate for Payer: Cash Price |
$1,491.79
|
Rate for Payer: Cigna Commercial |
$2,476.36
|
Rate for Payer: First Health Commercial |
$2,834.39
|
Rate for Payer: Humana Commercial |
$2,536.03
|
Rate for Payer: Humana KY Medicaid |
$1,026.05
|
Rate for Payer: Humana Medicare Advantage |
$475.79
|
Rate for Payer: Kentucky WC Medicaid |
$1,036.49
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,446.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,201.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$570.95
|
Rate for Payer: Molina Healthcare Medicaid |
$1,046.64
|
Rate for Payer: Ohio Health Choice Commercial |
$2,625.54
|
Rate for Payer: Ohio Health Group HMO |
$2,237.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$596.71
|
Rate for Payer: Ohio Health Group PPO No Differential |
$387.86
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.91
|
Rate for Payer: PHCS Commercial |
$2,864.23
|
Rate for Payer: United Healthcare All Payer |
$2,625.54
|
|
OTOLARYNGOLOGIC EXAM(T
|
Facility
|
IP
|
$2,983.57
|
|
Service Code
|
HCPCS 92502
|
Hospital Charge Code |
761T2449
|
Hospital Revenue Code
|
761
|
Min. Negotiated Rate |
$387.86 |
Max. Negotiated Rate |
$2,864.23 |
Rate for Payer: Aetna Commercial |
$2,297.35
|
Rate for Payer: Anthem POS/PPO/Traditional |
$2,327.18
|
Rate for Payer: Cash Price |
$1,491.79
|
Rate for Payer: Cigna Commercial |
$2,476.36
|
Rate for Payer: First Health Commercial |
$2,834.39
|
Rate for Payer: Humana Commercial |
$2,536.03
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$2,446.53
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,201.87
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$895.07
|
Rate for Payer: Ohio Health Choice Commercial |
$2,625.54
|
Rate for Payer: Ohio Health Group HMO |
$2,237.68
|
Rate for Payer: Ohio Health Group PPO Differential |
$596.71
|
Rate for Payer: Ohio Health Group PPO No Differential |
$387.86
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$924.91
|
Rate for Payer: PHCS Commercial |
$2,864.23
|
Rate for Payer: United Healthcare All Payer |
$2,625.54
|
|
OTOPLASTY BILATERAL
|
Professional
|
Both
|
$800.00
|
|
Hospital Charge Code |
22200043
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$280.00 |
Max. Negotiated Rate |
$800.00 |
Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
Rate for Payer: Cash Price |
$400.00
|
Rate for Payer: Multiplan PHCS |
$480.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
Rate for Payer: UHCCP Medicaid |
$280.00
|
|
OTOPLASTY BILATERAL -80
|
Professional
|
Both
|
$400.00
|
|
Hospital Charge Code |
22200376
|
Hospital Revenue Code
|
222
|
Min. Negotiated Rate |
$140.00 |
Max. Negotiated Rate |
$400.00 |
Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
Rate for Payer: Cash Price |
$200.00
|
Rate for Payer: Multiplan PHCS |
$240.00
|
Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
Rate for Payer: UHCCP Medicaid |
$140.00
|
|
OT RE EVAL CARE PLAN
|
Facility
|
IP
|
$135.00
|
|
Service Code
|
HCPCS 97168
|
Hospital Charge Code |
43000022
|
Hospital Revenue Code
|
434
|
Min. Negotiated Rate |
$17.55 |
Max. Negotiated Rate |
$129.60 |
Rate for Payer: Aetna Commercial |
$103.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
Rate for Payer: Cash Price |
$67.50
|
Rate for Payer: Cigna Commercial |
$112.05
|
Rate for Payer: First Health Commercial |
$128.25
|
Rate for Payer: Humana Commercial |
$114.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
Rate for Payer: Ohio Health Group HMO |
$101.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
Rate for Payer: PHCS Commercial |
$129.60
|
Rate for Payer: United Healthcare All Payer |
$118.80
|
|
OT RE EVAL CARE PLAN
|
Facility
|
OP
|
$135.00
|
|
Service Code
|
HCPCS 97168
|
Hospital Charge Code |
43000022
|
Hospital Revenue Code
|
434
|
Min. Negotiated Rate |
$17.55 |
Max. Negotiated Rate |
$129.60 |
Rate for Payer: Aetna Commercial |
$103.95
|
Rate for Payer: Anthem Medicaid |
$46.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
Rate for Payer: Cash Price |
$67.50
|
Rate for Payer: Cigna Commercial |
$112.05
|
Rate for Payer: First Health Commercial |
$128.25
|
Rate for Payer: Humana Commercial |
$114.75
|
Rate for Payer: Humana KY Medicaid |
$46.43
|
Rate for Payer: Kentucky WC Medicaid |
$46.90
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
Rate for Payer: Ohio Health Group HMO |
$101.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$27.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$17.55
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.85
|
Rate for Payer: PHCS Commercial |
$129.60
|
Rate for Payer: United Healthcare All Payer |
$118.80
|
|
OT WHIRLPOOL-EXTREMITY
|
Facility
|
IP
|
$149.00
|
|
Service Code
|
HCPCS 97022
|
Hospital Charge Code |
43000007
|
Hospital Revenue Code
|
431
|
Min. Negotiated Rate |
$19.37 |
Max. Negotiated Rate |
$143.04 |
Rate for Payer: Aetna Commercial |
$114.73
|
Rate for Payer: Anthem POS/PPO/Traditional |
$116.22
|
Rate for Payer: Cash Price |
$74.50
|
Rate for Payer: Cigna Commercial |
$123.67
|
Rate for Payer: First Health Commercial |
$141.55
|
Rate for Payer: Humana Commercial |
$126.65
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$122.18
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.96
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$44.70
|
Rate for Payer: Ohio Health Choice Commercial |
$131.12
|
Rate for Payer: Ohio Health Group HMO |
$111.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$29.80
|
Rate for Payer: Ohio Health Group PPO No Differential |
$19.37
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.19
|
Rate for Payer: PHCS Commercial |
$143.04
|
Rate for Payer: United Healthcare All Payer |
$131.12
|
|