|
STRAPPING REHAB
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 29540
|
| Hospital Charge Code |
42000065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
STRAPPING SHOULDER EC VALPEA(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
761P1056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$97.04 |
| Rate for Payer: Aetna Commercial |
$65.60
|
| Rate for Payer: Ambetter Exchange |
$16.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.66
|
| Rate for Payer: Anthem Medicaid |
$28.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$16.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.14
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$97.04
|
| Rate for Payer: Healthspan PPO |
$74.94
|
| Rate for Payer: Humana Medicaid |
$28.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$16.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.38
|
| Rate for Payer: Molina Healthcare Passport |
$28.80
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.81
|
| Rate for Payer: UHCCP Medicaid |
$18.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.78
|
|
|
STRAPPING SHOULDER EC VALPEA(T
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
761T1056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem Medicaid |
$91.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Humana KY Medicaid |
$91.82
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
STRAPPING SHOULDER EC VALPEA(T
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
761T1056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
STRAPPING SHOULDER EC VALPEAU
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
76101056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$16.78 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna Commercial |
$65.60
|
| Rate for Payer: Ambetter Exchange |
$16.78
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$17.66
|
| Rate for Payer: Anthem Medicaid |
$28.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$16.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$16.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.14
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$97.04
|
| Rate for Payer: Healthspan PPO |
$74.94
|
| Rate for Payer: Humana Medicaid |
$28.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.67
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$16.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$16.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.38
|
| Rate for Payer: Molina Healthcare Passport |
$28.80
|
| Rate for Payer: Multiplan PHCS |
$250.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.81
|
| Rate for Payer: UHCCP Medicaid |
$18.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$16.78
|
|
|
STRAPPING SHOULDER EC VALPEAU
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
45000193
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
STRAPPING SHOULDER EC VALPEAU
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
45000193
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem Medicaid |
$91.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Humana KY Medicaid |
$91.82
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
STRAPPING SHOULDER EC VALPEAU
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
76101056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
STRAPPING SHOULDER EC VALPEAU
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
76101056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$125.10 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
STRAPPING SHOULDER EG VELPEAU
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
42000064
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
STRAPPING SHOULDER EG VELPEAU
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 29240
|
| Hospital Charge Code |
42000064
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
STRAPPING THORAX
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
45000192
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem Medicaid |
$68.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Humana KY Medicaid |
$68.78
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$69.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
STRAPPING THORAX
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
STRAPPING THORAX
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
45000192
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$154.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$156.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$166.00
|
| Rate for Payer: First Health Commercial |
$190.00
|
| Rate for Payer: Humana Commercial |
$170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$164.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$147.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$176.00
|
| Rate for Payer: Ohio Health Group HMO |
$150.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$174.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.00
|
| Rate for Payer: PHCS Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Payer |
$176.00
|
|
|
STRAPPING THORAX
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
76101055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$66.03 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Humana KY Medicaid |
$66.03
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$66.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$67.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
STRAPPING THORAX
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
76101055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$149.76
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$159.36
|
| Rate for Payer: First Health Commercial |
$182.40
|
| Rate for Payer: Humana Commercial |
$163.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$157.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$141.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$168.96
|
| Rate for Payer: Ohio Health Group HMO |
$144.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$132.48
|
| Rate for Payer: PHCS Commercial |
$184.32
|
| Rate for Payer: United Healthcare All Payer |
$168.96
|
|
|
STRAPPING THORAX
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 29200
|
| Hospital Charge Code |
42000063
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$204.11 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$145.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$204.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$196.82
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$145.79
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$174.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
STRAPPING TOES
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
76101069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
STRAPPING TOES
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
45000204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem Medicaid |
$27.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Humana KY Medicaid |
$27.86
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$28.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
STRAPPING TOES
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
76101069
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.82
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
STRAPPING TOES
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
HCPCS 29550
|
| Hospital Charge Code |
45000204
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$77.76 |
| Rate for Payer: Aetna Commercial |
$62.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$63.18
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$67.23
|
| Rate for Payer: First Health Commercial |
$76.95
|
| Rate for Payer: Humana Commercial |
$68.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$66.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$71.28
|
| Rate for Payer: Ohio Health Group HMO |
$60.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.89
|
| Rate for Payer: PHCS Commercial |
$77.76
|
| Rate for Payer: United Healthcare All Payer |
$71.28
|
|
|
STRATTERA 100MG EQUIV CAPSULE
|
Facility
|
IP
|
$9.91
|
|
|
Service Code
|
NDC 64980037903
|
| Hospital Charge Code |
25003496
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.73
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: First Health Commercial |
$9.41
|
| Rate for Payer: Humana Commercial |
$8.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.72
|
| Rate for Payer: Ohio Health Group HMO |
$7.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.84
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
STRATTERA 100MG EQUIV CAPSULE
|
Facility
|
OP
|
$9.91
|
|
|
Service Code
|
NDC 64980037903
|
| Hospital Charge Code |
25003496
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$9.51 |
| Rate for Payer: Aetna Commercial |
$7.63
|
| Rate for Payer: Anthem Medicaid |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.73
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cigna Commercial |
$8.23
|
| Rate for Payer: First Health Commercial |
$9.41
|
| Rate for Payer: Humana Commercial |
$8.42
|
| Rate for Payer: Humana KY Medicaid |
$3.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.72
|
| Rate for Payer: Ohio Health Group HMO |
$7.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.84
|
| Rate for Payer: PHCS Commercial |
$9.51
|
| Rate for Payer: United Healthcare All Payer |
$8.72
|
|
|
STRATTERA 10MG CAPSULE
|
Facility
|
OP
|
$30.18
|
|
|
Service Code
|
NDC 2322730
|
| Hospital Charge Code |
25001436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Anthem Medicaid |
$10.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.54
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cigna Commercial |
$25.05
|
| Rate for Payer: First Health Commercial |
$28.67
|
| Rate for Payer: Humana Commercial |
$25.65
|
| Rate for Payer: Humana KY Medicaid |
$10.38
|
| Rate for Payer: Kentucky WC Medicaid |
$10.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.56
|
| Rate for Payer: Ohio Health Group HMO |
$22.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.82
|
| Rate for Payer: PHCS Commercial |
$28.97
|
| Rate for Payer: United Healthcare All Payer |
$26.56
|
|
|
STRATTERA 10MG CAPSULE
|
Facility
|
IP
|
$30.18
|
|
|
Service Code
|
NDC 2322730
|
| Hospital Charge Code |
25001436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.05 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.54
|
| Rate for Payer: Cash Price |
$15.09
|
| Rate for Payer: Cigna Commercial |
$25.05
|
| Rate for Payer: First Health Commercial |
$28.67
|
| Rate for Payer: Humana Commercial |
$25.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.56
|
| Rate for Payer: Ohio Health Group HMO |
$22.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.82
|
| Rate for Payer: PHCS Commercial |
$28.97
|
| Rate for Payer: United Healthcare All Payer |
$26.56
|
|
