|
ACHILLES TENDON W/O BONE
|
Facility
|
OP
|
$12,607.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.98 |
| Max. Negotiated Rate |
$12,103.20 |
| Rate for Payer: Aetna Commercial |
$9,707.78
|
| Rate for Payer: Anthem Medicaid |
$4,335.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,833.85
|
| Rate for Payer: Cash Price |
$6,303.75
|
| Rate for Payer: Cigna Commercial |
$10,464.22
|
| Rate for Payer: First Health Commercial |
$11,977.12
|
| Rate for Payer: Humana Commercial |
$10,716.38
|
| Rate for Payer: Humana KY Medicaid |
$4,335.72
|
| Rate for Payer: Kentucky WC Medicaid |
$4,379.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,338.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,304.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,422.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,094.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,455.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.32
|
| Rate for Payer: PHCS Commercial |
$12,103.20
|
| Rate for Payer: United Healthcare All Payer |
$11,094.60
|
|
|
ACID FAST CONCENTRATION
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
30001246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
ACID FAST CONCENTRATION
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 87015
|
| Hospital Charge Code |
30001246
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$59.29
|
| Rate for Payer: Anthem Medicaid |
$6.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.68
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: First Health Commercial |
$73.15
|
| Rate for Payer: Humana Commercial |
$65.45
|
| Rate for Payer: Humana KY Medicaid |
$6.68
|
| Rate for Payer: Humana Medicare Advantage |
$6.68
|
| Rate for Payer: Kentucky WC Medicaid |
$6.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$56.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$67.76
|
| Rate for Payer: Ohio Health Group HMO |
$57.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$23.87
|
| Rate for Payer: PHCS Commercial |
$73.92
|
| Rate for Payer: United Healthcare All Payer |
$67.76
|
|
|
ACID FAST SMEAR
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
30001327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
ACID FAST SMEAR
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 87206
|
| Hospital Charge Code |
30001327
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$70.84
|
| Rate for Payer: Anthem Medicaid |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.39
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: First Health Commercial |
$87.40
|
| Rate for Payer: Humana Commercial |
$78.20
|
| Rate for Payer: Humana KY Medicaid |
$5.39
|
| Rate for Payer: Humana Medicare Advantage |
$5.39
|
| Rate for Payer: Kentucky WC Medicaid |
$5.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.96
|
| Rate for Payer: Ohio Health Group HMO |
$69.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28.52
|
| Rate for Payer: PHCS Commercial |
$88.32
|
| Rate for Payer: United Healthcare All Payer |
$80.96
|
|
|
ACINETOBACTER RPSA GENE
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
ACINETOBACTER RPSA GENE
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
ACL TIGHTROPE RT
|
Facility
|
IP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
ACL TIGHTROPE RT
|
Facility
|
OP
|
$3,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.25 |
| Max. Negotiated Rate |
$3,288.00 |
| Rate for Payer: Aetna Commercial |
$2,637.25
|
| Rate for Payer: Anthem Medicaid |
$1,177.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,671.50
|
| Rate for Payer: Cash Price |
$1,712.50
|
| Rate for Payer: Cigna Commercial |
$2,842.75
|
| Rate for Payer: First Health Commercial |
$3,253.75
|
| Rate for Payer: Humana Commercial |
$2,911.25
|
| Rate for Payer: Humana KY Medicaid |
$1,177.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,189.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,808.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,527.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,027.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,201.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,014.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,568.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,061.75
|
| Rate for Payer: PHCS Commercial |
$3,288.00
|
| Rate for Payer: United Healthcare All Payer |
$3,014.00
|
|
|
ACNE PRE TX PROGRAM KIT US
|
Professional
|
Both
|
$140.00
|
|
| Hospital Charge Code |
22200154
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$140.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$98.00
|
| Rate for Payer: UHCCP Medicaid |
$49.00
|
|
|
ACNE SURGERY (EG - MARSUPIALI
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$405.12 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Anthem Medicaid |
$145.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$350.26
|
| Rate for Payer: First Health Commercial |
$400.90
|
| Rate for Payer: Humana Commercial |
$358.70
|
| Rate for Payer: Humana KY Medicaid |
$145.13
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$146.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$346.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$148.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.36
|
| Rate for Payer: Ohio Health Group HMO |
$316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.82
|
| Rate for Payer: PHCS Commercial |
$405.12
|
| Rate for Payer: United Healthcare All Payer |
$371.36
|
|
|
ACNE SURGERY (EG - MARSUPIALI
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.86 |
| Max. Negotiated Rate |
$405.12 |
| Rate for Payer: Aetna Commercial |
$324.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$329.16
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$350.26
|
| Rate for Payer: First Health Commercial |
$400.90
|
| Rate for Payer: Humana Commercial |
$358.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$346.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$311.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$371.36
|
| Rate for Payer: Ohio Health Group HMO |
$316.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$84.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.82
|
| Rate for Payer: PHCS Commercial |
$405.12
|
| Rate for Payer: United Healthcare All Payer |
$371.36
|
|
|
ACNE SURGERY (EG - MARSUPIALI
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
76100007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$422.00 |
| Rate for Payer: Aetna Commercial |
$123.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.33
|
| Rate for Payer: Anthem Medicaid |
$44.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$422.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cash Price |
$211.00
|
| Rate for Payer: Cigna Commercial |
$126.11
|
| Rate for Payer: Healthspan PPO |
$111.71
|
| Rate for Payer: Humana Medicaid |
$44.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.23
|
| Rate for Payer: Molina Healthcare Passport |
$44.34
|
| Rate for Payer: Multiplan PHCS |
$253.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$295.40
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.78
|
|
|
ACNE SURGERY (EG - MARSUPIAL(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
761P0007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$123.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$48.33
|
| Rate for Payer: Anthem Medicaid |
$44.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$126.11
|
| Rate for Payer: Healthspan PPO |
$111.71
|
| Rate for Payer: Humana Medicaid |
$44.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.40
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$45.23
|
| Rate for Payer: Molina Healthcare Passport |
$44.34
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$50.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$44.78
|
|
|
ACNE SURGERY (EG - MARSUPIAL(T
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
761T0007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
ACNE SURGERY (EG - MARSUPIAL(T
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
HCPCS 10040
|
| Hospital Charge Code |
761T0007
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$261.12 |
| Rate for Payer: Aetna Commercial |
$209.44
|
| Rate for Payer: Anthem Medicaid |
$93.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cigna Commercial |
$225.76
|
| Rate for Payer: First Health Commercial |
$258.40
|
| Rate for Payer: Humana Commercial |
$231.20
|
| Rate for Payer: Humana KY Medicaid |
$93.54
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Kentucky WC Medicaid |
$94.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$200.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$239.36
|
| Rate for Payer: Ohio Health Group HMO |
$204.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$54.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$84.32
|
| Rate for Payer: PHCS Commercial |
$261.12
|
| Rate for Payer: United Healthcare All Payer |
$239.36
|
|
|
ACOUSTIC REFLEX TESTING
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 92568
|
| Hospital Charge Code |
47000014
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem Medicaid |
$30.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.82
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Humana KY Medicaid |
$30.61
|
| Rate for Payer: Humana Medicare Advantage |
$34.68
|
| Rate for Payer: Kentucky WC Medicaid |
$30.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.59
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
ACOUSTIC REFLEX TESTING
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 92568
|
| Hospital Charge Code |
47000014
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.59
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
ACRO CLAV JTS W/WO WGT BIL
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
32000077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
ACRO CLAV JTS W/WO WGT BIL
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
32000077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$335.00 |
| Rate for Payer: Aetna Commercial |
$54.17
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$53.71
|
| Rate for Payer: Healthspan PPO |
$50.76
|
| Rate for Payer: Humana Medicaid |
$26.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.19
|
| Rate for Payer: Molina Healthcare Passport |
$26.66
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$117.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.93
|
|
|
ACRO CLAV JTS W/WO WGT BIL
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
32000077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.55 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$67.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.85
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
ACRO CLAV JTS W/WO WGT BIL(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
320P0077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$54.17 |
| Rate for Payer: Aetna Commercial |
$54.17
|
| Rate for Payer: Anthem Medicaid |
$26.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$53.71
|
| Rate for Payer: Healthspan PPO |
$50.76
|
| Rate for Payer: Humana Medicaid |
$26.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$14.42
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.19
|
| Rate for Payer: Molina Healthcare Passport |
$26.66
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.93
|
|
|
ACRO CLAV JTS W/WO WGT BIL(T
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
320T0077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
ACRO CLAV JTS W/WO WGT BIL(T
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
HCPCS 73050
|
| Hospital Charge Code |
320T0077
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.05 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Anthem Medicaid |
$98.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$222.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: First Health Commercial |
$270.75
|
| Rate for Payer: Humana Commercial |
$242.25
|
| Rate for Payer: Humana KY Medicaid |
$98.01
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$99.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$210.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$99.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$250.80
|
| Rate for Payer: Ohio Health Group HMO |
$213.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.35
|
| Rate for Payer: PHCS Commercial |
$273.60
|
| Rate for Payer: United Healthcare All Payer |
$250.80
|
|
|
ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL LIGAMENT RELEASE
|
Facility
|
OP
|
$3,918.70
|
|
|
Service Code
|
CPT 23130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,799.07 |
| Max. Negotiated Rate |
$3,918.70 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,799.07
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,918.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,778.74
|
| Rate for Payer: Humana Medicare Advantage |
$2,799.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,358.88
|
|
