|
SPECIAL GROUP THERAPY
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90000011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$262.00 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Anthem Medicaid |
$18.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$262.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$40.18
|
| Rate for Payer: Healthspan PPO |
$37.11
|
| Rate for Payer: Humana Medicaid |
$18.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.20
|
| Rate for Payer: Molina Healthcare Passport |
$18.82
|
| Rate for Payer: Multiplan PHCS |
$157.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.40
|
| Rate for Payer: UHCCP Medicaid |
$91.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.01
|
|
|
SPECIAL GROUP THERAPY(P
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
900P0011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Anthem Medicaid |
$18.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$40.18
|
| Rate for Payer: Healthspan PPO |
$37.11
|
| Rate for Payer: Humana Medicaid |
$18.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.20
|
| Rate for Payer: Molina Healthcare Passport |
$18.82
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.01
|
|
|
SPECIAL GROUP THERAPY(T
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
900T0011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.10
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
SPECIAL GROUP THERAPY(T
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
900T0011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Aetna Commercial |
$161.70
|
| Rate for Payer: Anthem Medicaid |
$72.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$77.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$107.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.06
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$174.30
|
| Rate for Payer: First Health Commercial |
$199.50
|
| Rate for Payer: Humana Commercial |
$178.50
|
| Rate for Payer: Humana KY Medicaid |
$72.22
|
| Rate for Payer: Humana Medicare Advantage |
$77.08
|
| Rate for Payer: Kentucky WC Medicaid |
$72.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$172.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$92.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$73.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$184.80
|
| Rate for Payer: Ohio Health Group HMO |
$157.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.10
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
SPECIAL PHYSICS
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
33300019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$800.64 |
| Rate for Payer: Aetna Commercial |
$642.18
|
| Rate for Payer: Anthem Medicaid |
$286.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$650.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$692.22
|
| Rate for Payer: First Health Commercial |
$792.30
|
| Rate for Payer: Humana Commercial |
$708.90
|
| Rate for Payer: Humana KY Medicaid |
$286.81
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$289.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$683.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$615.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$733.92
|
| Rate for Payer: Ohio Health Group HMO |
$625.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.54
|
| Rate for Payer: PHCS Commercial |
$800.64
|
| Rate for Payer: United Healthcare All Payer |
$733.92
|
|
|
SPECIAL PHYSICS
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
33300019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$834.00 |
| Rate for Payer: Aetna Commercial |
$178.19
|
| Rate for Payer: Anthem Medicaid |
$94.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$834.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$196.59
|
| Rate for Payer: Healthspan PPO |
$150.27
|
| Rate for Payer: Humana Medicaid |
$94.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.31
|
| Rate for Payer: Molina Healthcare Passport |
$94.42
|
| Rate for Payer: Multiplan PHCS |
$500.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$583.80
|
| Rate for Payer: UHCCP Medicaid |
$291.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.36
|
|
|
SPECIAL PHYSICS
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
33300019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$800.64 |
| Rate for Payer: Aetna Commercial |
$642.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$650.52
|
| Rate for Payer: Cash Price |
$417.00
|
| Rate for Payer: Cigna Commercial |
$692.22
|
| Rate for Payer: First Health Commercial |
$792.30
|
| Rate for Payer: Humana Commercial |
$708.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$683.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$615.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$733.92
|
| Rate for Payer: Ohio Health Group HMO |
$625.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$166.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.54
|
| Rate for Payer: PHCS Commercial |
$800.64
|
| Rate for Payer: United Healthcare All Payer |
$733.92
|
|
|
SPECIAL PHYSICS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
333P0019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.42 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$178.19
|
| Rate for Payer: Anthem Medicaid |
$94.42
|
| 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 |
$196.59
|
| Rate for Payer: Healthspan PPO |
$150.27
|
| Rate for Payer: Humana Medicaid |
$94.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$143.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.31
|
| Rate for Payer: Molina Healthcare Passport |
$94.42
|
| 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 |
$95.36
|
|
|
SPECIAL PHYSICS(T
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
333T0019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SPECIAL PHYSICS(T
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
333T0019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$512.64 |
| Rate for Payer: Aetna Commercial |
$411.18
|
| Rate for Payer: Anthem Medicaid |
$183.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$117.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$416.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$164.26
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.40
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$443.22
|
| Rate for Payer: First Health Commercial |
$507.30
|
| Rate for Payer: Humana Commercial |
$453.90
|
| Rate for Payer: Humana KY Medicaid |
$183.64
|
| Rate for Payer: Humana Medicare Advantage |
$117.33
|
| Rate for Payer: Kentucky WC Medicaid |
$185.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$437.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$469.92
|
| Rate for Payer: Ohio Health Group HMO |
$400.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$106.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$165.54
|
| Rate for Payer: PHCS Commercial |
$512.64
|
| Rate for Payer: United Healthcare All Payer |
$469.92
|
|
|
SPECIAL PROCEDURE 3D
|
Facility
|
IP
|
$2,597.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$337.61 |
| Max. Negotiated Rate |
$2,493.12 |
| Rate for Payer: Aetna Commercial |
$1,999.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,025.66
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cigna Commercial |
$2,155.51
|
| Rate for Payer: First Health Commercial |
$2,467.15
|
| Rate for Payer: Humana Commercial |
$2,207.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,129.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,916.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$779.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,285.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.07
|
| Rate for Payer: PHCS Commercial |
$2,493.12
|
| Rate for Payer: United Healthcare All Payer |
$2,285.36
|
|
|
SPECIAL PROCEDURE 3D
|
Professional
|
Both
|
$2,597.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$2,597.00 |
| Rate for Payer: Aetna Commercial |
$406.50
|
| Rate for Payer: Anthem Medicaid |
$390.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,597.00
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cigna Commercial |
$666.26
|
| Rate for Payer: Healthspan PPO |
$342.81
|
| Rate for Payer: Humana Medicaid |
$390.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.37
|
| Rate for Payer: Molina Healthcare Passport |
$390.56
|
| Rate for Payer: Multiplan PHCS |
$1,558.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,817.90
|
| Rate for Payer: UHCCP Medicaid |
$908.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.47
|
|
|
SPECIAL PROCEDURE 3D
|
Facility
|
OP
|
$2,597.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
33300028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$337.61 |
| Max. Negotiated Rate |
$2,493.12 |
| Rate for Payer: Aetna Commercial |
$1,999.69
|
| Rate for Payer: Anthem Medicaid |
$893.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$509.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,025.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$712.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.22
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cash Price |
$1,298.50
|
| Rate for Payer: Cigna Commercial |
$2,155.51
|
| Rate for Payer: First Health Commercial |
$2,467.15
|
| Rate for Payer: Humana Commercial |
$2,207.45
|
| Rate for Payer: Humana KY Medicaid |
$893.11
|
| Rate for Payer: Humana Medicare Advantage |
$509.05
|
| Rate for Payer: Kentucky WC Medicaid |
$902.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,129.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,916.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$911.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,285.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,947.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$519.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.07
|
| Rate for Payer: PHCS Commercial |
$2,493.12
|
| Rate for Payer: United Healthcare All Payer |
$2,285.36
|
|
|
SPECIAL PROCEDURE 3D(P
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
333P0028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$406.50
|
| Rate for Payer: Anthem Medicaid |
$390.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$750.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$666.26
|
| Rate for Payer: Healthspan PPO |
$342.81
|
| Rate for Payer: Humana Medicaid |
$390.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$398.37
|
| Rate for Payer: Molina Healthcare Passport |
$390.56
|
| Rate for Payer: Multiplan PHCS |
$450.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$525.00
|
| Rate for Payer: UHCCP Medicaid |
$262.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$394.47
|
|
|
SPECIAL PROCEDURE 3D(T
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
333T0028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
SPECIAL PROCEDURE 3D(T
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS 77470
|
| Hospital Charge Code |
333T0028
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$509.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$712.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$687.22
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Humana Medicare Advantage |
$509.05
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$610.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30002034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30002034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$207.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$89.07
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$89.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
SPECIAL STAINS GROUP 2
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30002034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$265.00 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Anthem Medicaid |
$51.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.00
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Healthspan PPO |
$101.92
|
| Rate for Payer: Humana Medicaid |
$51.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.46
|
| Rate for Payer: Molina Healthcare Passport |
$51.43
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.50
|
| Rate for Payer: UHCCP Medicaid |
$92.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.94
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001515
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SPECIAL STAINS GROUP 2
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001515
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.90 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$71.30
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
SPECIAL STAINS GROUP 2
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
30001515
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Anthem Medicaid |
$51.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Healthspan PPO |
$101.92
|
| Rate for Payer: Humana Medicaid |
$51.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.46
|
| Rate for Payer: Molina Healthcare Passport |
$51.43
|
| Rate for Payer: Multiplan PHCS |
$138.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$161.00
|
| Rate for Payer: UHCCP Medicaid |
$80.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.94
|
|
|
SPECIAL STAINS GROUP 2 (P
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
300P2034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$107.33 |
| Rate for Payer: Aetna Commercial |
$107.33
|
| Rate for Payer: Anthem Medicaid |
$51.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.00
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Healthspan PPO |
$101.92
|
| Rate for Payer: Humana Medicaid |
$51.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$6.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$52.46
|
| Rate for Payer: Molina Healthcare Passport |
$51.43
|
| Rate for Payer: Multiplan PHCS |
$21.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$24.50
|
| Rate for Payer: UHCCP Medicaid |
$12.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.94
|
|
|
SPECIAL STAINS GROUP 2 (T
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
300T2034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$175.56
|
| Rate for Payer: Anthem Medicaid |
$78.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$189.24
|
| Rate for Payer: First Health Commercial |
$216.60
|
| Rate for Payer: Humana Commercial |
$193.80
|
| Rate for Payer: Humana KY Medicaid |
$78.41
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$79.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$168.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$200.64
|
| Rate for Payer: Ohio Health Group HMO |
$171.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.68
|
| Rate for Payer: PHCS Commercial |
$218.88
|
| Rate for Payer: United Healthcare All Payer |
$200.64
|
|
|
SPECIAL STAINS GROUP 2 (T
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
300T2034
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.64 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna Commercial |
$175.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.08
|
| Rate for Payer: Cash Price |
$114.00
|
| Rate for Payer: Cigna Commercial |
$189.24
|
| Rate for Payer: First Health Commercial |
$216.60
|
| Rate for Payer: Humana Commercial |
$193.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$186.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$168.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$200.64
|
| Rate for Payer: Ohio Health Group HMO |
$171.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.68
|
| Rate for Payer: PHCS Commercial |
$218.88
|
| Rate for Payer: United Healthcare All Payer |
$200.64
|
|
