|
SPEC EF PRI SO 12/14 SZ 5
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF PRI SO 12/14 SZ 5
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 1
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 1
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 2
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 2
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 3
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 3
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 4
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 4
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 5
|
Facility
|
OP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem Medicaid |
$6,026.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Humana KY Medicaid |
$6,026.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6,087.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,147.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPEC EF SO CLS 12/14 SZ 5
|
Facility
|
IP
|
$17,524.08
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,257.22 |
| Max. Negotiated Rate |
$16,823.12 |
| Rate for Payer: Aetna Commercial |
$13,493.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,668.78
|
| Rate for Payer: Cash Price |
$8,762.04
|
| Rate for Payer: Cigna Commercial |
$14,544.99
|
| Rate for Payer: First Health Commercial |
$16,647.88
|
| Rate for Payer: Humana Commercial |
$14,895.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,369.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,932.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,257.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,421.19
|
| Rate for Payer: Ohio Health Group HMO |
$13,143.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,019.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,245.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,091.62
|
| Rate for Payer: PHCS Commercial |
$16,823.12
|
| Rate for Payer: United Healthcare All Payer |
$15,421.19
|
|
|
SPECIAL ANESTH PT<1 YO
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
37000176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Aetna Commercial |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$25.00
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Healthspan PPO |
$61.00
|
| Rate for Payer: Humana Medicaid |
$25.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.50
|
| Rate for Payer: Molina Healthcare Passport |
$25.00
|
| Rate for Payer: Multiplan PHCS |
$154.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$179.90
|
| Rate for Payer: UHCCP Medicaid |
$89.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.25
|
|
|
SPECIAL ANESTH PT<1 YO
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
37000176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem Medicaid |
$88.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Humana KY Medicaid |
$88.38
|
| Rate for Payer: Kentucky WC Medicaid |
$89.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.33
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SPECIAL ANESTH PT<1 YO
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
37000176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$205.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.33
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SPECIAL ANESTH PT<1 YO(P
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
370P0176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$78.34 |
| Rate for Payer: Aetna Commercial |
$78.34
|
| Rate for Payer: Anthem Medicaid |
$25.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Healthspan PPO |
$61.00
|
| Rate for Payer: Humana Medicaid |
$25.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$25.50
|
| Rate for Payer: Molina Healthcare Passport |
$25.00
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.25
|
|
|
SPECIAL ANESTH PT<1 YO(T
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
370T0176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem Medicaid |
$59.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Humana KY Medicaid |
$59.15
|
| Rate for Payer: Kentucky WC Medicaid |
$59.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$60.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
SPECIAL ANESTH PT<1 YO(T
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS 99100
|
| Hospital Charge Code |
370T0176
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$165.12 |
| Rate for Payer: Aetna Commercial |
$132.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.16
|
| Rate for Payer: Cash Price |
$86.00
|
| Rate for Payer: Cigna Commercial |
$142.76
|
| Rate for Payer: First Health Commercial |
$163.40
|
| Rate for Payer: Humana Commercial |
$146.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$141.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$151.36
|
| Rate for Payer: Ohio Health Group HMO |
$129.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$118.68
|
| Rate for Payer: PHCS Commercial |
$165.12
|
| Rate for Payer: United Healthcare All Payer |
$151.36
|
|
|
SPECIAL GROUP THERAPY
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90000011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.36
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.78
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
SPECIAL GROUP THERAPY
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90000011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$157.20 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Ambetter Exchange |
$24.05
|
| Rate for Payer: Anthem Medicaid |
$19.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.86
|
| 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 |
$19.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.68
|
| Rate for Payer: Molina Healthcare Passport |
$19.29
|
| Rate for Payer: Multiplan PHCS |
$157.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.27
|
| Rate for Payer: UHCCP Medicaid |
$91.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.05
|
|
|
SPECIAL GROUP THERAPY
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
90000011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$251.52 |
| Rate for Payer: Aetna Commercial |
$201.74
|
| Rate for Payer: Anthem Medicaid |
$90.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$204.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cash Price |
$131.00
|
| Rate for Payer: Cigna Commercial |
$217.46
|
| Rate for Payer: First Health Commercial |
$248.90
|
| Rate for Payer: Humana Commercial |
$222.70
|
| Rate for Payer: Humana KY Medicaid |
$90.10
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$91.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$193.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$230.56
|
| Rate for Payer: Ohio Health Group HMO |
$196.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$209.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$180.78
|
| Rate for Payer: PHCS Commercial |
$251.52
|
| Rate for Payer: United Healthcare All Payer |
$230.56
|
|
|
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 |
$46.01 |
| Rate for Payer: Aetna Commercial |
$46.01
|
| Rate for Payer: Ambetter Exchange |
$24.05
|
| Rate for Payer: Anthem Medicaid |
$19.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$28.86
|
| 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 |
$19.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.68
|
| Rate for Payer: Molina Healthcare Passport |
$19.29
|
| Rate for Payer: Multiplan PHCS |
$31.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$31.27
|
| Rate for Payer: UHCCP Medicaid |
$18.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.05
|
|
|
SPECIAL GROUP THERAPY(T
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
900T0011
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$63.00 |
| 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 |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| 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 |
$72.22 |
| 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 |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| 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 |
$85.47
|
| 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 |
$102.56
|
| 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 |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$144.90
|
| Rate for Payer: PHCS Commercial |
$201.60
|
| Rate for Payer: United Healthcare All Payer |
$184.80
|
|
|
SPECIAL PHYSICS
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
HCPCS 77370
|
| Hospital Charge Code |
33300019
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$122.68 |
| Max. Negotiated Rate |
$834.24 |
| Rate for Payer: Aetna Commercial |
$669.13
|
| Rate for Payer: Anthem Medicaid |
$298.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$122.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$677.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$171.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$165.62
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cash Price |
$434.50
|
| Rate for Payer: Cigna Commercial |
$721.27
|
| Rate for Payer: First Health Commercial |
$825.55
|
| Rate for Payer: Humana Commercial |
$738.65
|
| Rate for Payer: Humana KY Medicaid |
$298.85
|
| Rate for Payer: Humana Medicare Advantage |
$122.68
|
| Rate for Payer: Kentucky WC Medicaid |
$301.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$712.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$641.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$304.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$764.72
|
| Rate for Payer: Ohio Health Group HMO |
$651.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.61
|
| Rate for Payer: PHCS Commercial |
$834.24
|
| Rate for Payer: United Healthcare All Payer |
$764.72
|
|
