|
UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
|
Facility
|
OP
|
$241.25
|
|
|
Service Code
|
CPT 59899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$172.32 |
| Max. Negotiated Rate |
$241.25 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$172.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$241.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$232.63
|
| Rate for Payer: Humana Medicare Advantage |
$172.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$206.78
|
|
|
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
|
Facility
|
OP
|
$285.50
|
|
|
Service Code
|
CPT 27299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$285.50 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
|
|
UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
|
Facility
|
OP
|
$242.37
|
|
|
Service Code
|
CPT 17999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.12 |
| Max. Negotiated Rate |
$242.37 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$173.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$242.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$233.71
|
| Rate for Payer: Humana Medicare Advantage |
$173.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.74
|
|
|
UNLISTED PROCEDURE, STOMACH
|
Facility
|
OP
|
$1,097.45
|
|
|
Service Code
|
CPT 43999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$783.89 |
| Max. Negotiated Rate |
$1,097.45 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$783.89
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,097.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,058.25
|
| Rate for Payer: Humana Medicare Advantage |
$783.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$940.67
|
|
|
UNLISTED PROCEDURE, VASCULAR SURGERY
|
Facility
|
OP
|
$760.54
|
|
|
Service Code
|
CPT 37799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.24 |
| Max. Negotiated Rate |
$760.54 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$543.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$760.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$733.37
|
| Rate for Payer: Humana Medicare Advantage |
$543.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.89
|
|
|
UNVRSL C-TAPR+0MM ADJSTMT SLV
|
Facility
|
OP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem Medicaid |
$3,745.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Humana KY Medicaid |
$3,745.76
|
| Rate for Payer: Kentucky WC Medicaid |
$3,783.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,820.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
UNVRSL C-TAPR+0MM ADJSTMT SLV
|
Facility
|
IP
|
$10,892.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.96 |
| Max. Negotiated Rate |
$10,456.32 |
| Rate for Payer: Aetna Commercial |
$8,386.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,495.76
|
| Rate for Payer: Cash Price |
$5,446.00
|
| Rate for Payer: Cigna Commercial |
$9,040.36
|
| Rate for Payer: First Health Commercial |
$10,347.40
|
| Rate for Payer: Humana Commercial |
$9,258.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,931.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,038.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,267.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,584.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,169.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,178.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,415.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,376.52
|
| Rate for Payer: PHCS Commercial |
$10,456.32
|
| Rate for Payer: United Healthcare All Payer |
$9,584.96
|
|
|
UNVRSL C- TAPR -2.5MM ADJST SL
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.14 |
| Max. Negotiated Rate |
$1,994.88 |
| Rate for Payer: Aetna Commercial |
$1,600.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,620.84
|
| Rate for Payer: Cash Price |
$1,039.00
|
| Rate for Payer: Cigna Commercial |
$1,724.74
|
| Rate for Payer: First Health Commercial |
$1,974.10
|
| Rate for Payer: Humana Commercial |
$1,766.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,703.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,533.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,828.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$644.18
|
| Rate for Payer: PHCS Commercial |
$1,994.88
|
| Rate for Payer: United Healthcare All Payer |
$1,828.64
|
|
|
UNVRSL C- TAPR -2.5MM ADJST SL
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.14 |
| Max. Negotiated Rate |
$1,994.88 |
| Rate for Payer: Aetna Commercial |
$1,600.06
|
| Rate for Payer: Anthem Medicaid |
$714.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,620.84
|
| Rate for Payer: Cash Price |
$1,039.00
|
| Rate for Payer: Cigna Commercial |
$1,724.74
|
| Rate for Payer: First Health Commercial |
$1,974.10
|
| Rate for Payer: Humana Commercial |
$1,766.30
|
| Rate for Payer: Humana KY Medicaid |
$714.62
|
| Rate for Payer: Kentucky WC Medicaid |
$721.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,703.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,533.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$728.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,828.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$644.18
|
| Rate for Payer: PHCS Commercial |
$1,994.88
|
| Rate for Payer: United Healthcare All Payer |
$1,828.64
|
|
|
UNVRSL C-TAPR+2.5MM ADJST SLV
|
Facility
|
OP
|
$2,078.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.14 |
| Max. Negotiated Rate |
$1,994.88 |
| Rate for Payer: Aetna Commercial |
$1,600.06
|
| Rate for Payer: Anthem Medicaid |
$714.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,620.84
|
| Rate for Payer: Cash Price |
$1,039.00
|
| Rate for Payer: Cigna Commercial |
$1,724.74
|
| Rate for Payer: First Health Commercial |
$1,974.10
|
| Rate for Payer: Humana Commercial |
$1,766.30
|
| Rate for Payer: Humana KY Medicaid |
$714.62
|
| Rate for Payer: Kentucky WC Medicaid |
$721.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,703.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,533.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$728.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,828.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$644.18
|
| Rate for Payer: PHCS Commercial |
$1,994.88
|
| Rate for Payer: United Healthcare All Payer |
$1,828.64
|
|
|
UNVRSL C-TAPR+2.5MM ADJST SLV
|
Facility
|
IP
|
$2,078.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.14 |
| Max. Negotiated Rate |
$1,994.88 |
| Rate for Payer: Aetna Commercial |
$1,600.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,620.84
|
| Rate for Payer: Cash Price |
$1,039.00
|
| Rate for Payer: Cigna Commercial |
$1,724.74
|
| Rate for Payer: First Health Commercial |
$1,974.10
|
| Rate for Payer: Humana Commercial |
$1,766.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,703.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,533.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,828.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,558.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$415.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$644.18
|
| Rate for Payer: PHCS Commercial |
$1,994.88
|
| Rate for Payer: United Healthcare All Payer |
$1,828.64
|
|
|
UPGRADE OF PACEMAKER SYSTEM
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
76101248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.62 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna Commercial |
$829.76
|
| Rate for Payer: Anthem Medicaid |
$388.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,840.00
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$786.42
|
| Rate for Payer: Healthspan PPO |
$815.81
|
| Rate for Payer: Humana Medicaid |
$388.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$679.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.39
|
| Rate for Payer: Molina Healthcare Passport |
$388.62
|
| Rate for Payer: Multiplan PHCS |
$1,104.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,288.00
|
| Rate for Payer: UHCCP Medicaid |
$644.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.51
|
|
|
UPGRADE OF PACEMAKER SYSTEM
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
76101248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$12,927.70 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,234.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12,927.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,465.99
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Humana Medicare Advantage |
$9,234.07
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,080.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
UPGRADE OF PACEMAKER SYSTEM
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
76101248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
UPGRADE OF PACEMAKER SYSTEM(P
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 33214
|
| Hospital Charge Code |
761P1248
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$388.62 |
| Max. Negotiated Rate |
$1,840.00 |
| Rate for Payer: Aetna Commercial |
$829.76
|
| Rate for Payer: Anthem Medicaid |
$388.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,840.00
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$786.42
|
| Rate for Payer: Healthspan PPO |
$815.81
|
| Rate for Payer: Humana Medicaid |
$388.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$679.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.39
|
| Rate for Payer: Molina Healthcare Passport |
$388.62
|
| Rate for Payer: Multiplan PHCS |
$1,104.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,288.00
|
| Rate for Payer: UHCCP Medicaid |
$644.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$392.51
|
|
|
UPPER ARM/ELBOW SURGERY
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
76102619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
|
|
UPPER ARM/ELBOW SURGERY
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
76102619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
UPPER ARM/ELBOW SURGERY
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
76102619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
UPPER ARM/ELBOW SURGERY
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 24999
|
| Hospital Charge Code |
761P2619
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$800.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
|
|
UPPER EXT. FOREARM LT 2V
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
32000082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
UPPER EXT. FOREARM LT 2V
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
32000082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
UPPER EXT. FOREARM LT 2V
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
32000082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.24
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$223.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.40
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
|
|
UPPER EXT. FOREARM LT 2V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
320P0082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$40.84 |
| Rate for Payer: Aetna Commercial |
$40.80
|
| Rate for Payer: Anthem Medicaid |
$20.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$40.84
|
| Rate for Payer: Healthspan PPO |
$38.24
|
| Rate for Payer: Humana Medicaid |
$20.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.38
|
| Rate for Payer: Molina Healthcare Passport |
$20.96
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.17
|
|
|
UPPER EXT. FOREARM LT 2V(T
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
320T0082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
|
UPPER EXT. FOREARM LT 2V(T
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS 73090
|
| Hospital Charge Code |
320T0082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$318.72 |
| Rate for Payer: Aetna Commercial |
$255.64
|
| Rate for Payer: Anthem Medicaid |
$114.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cigna Commercial |
$275.56
|
| Rate for Payer: First Health Commercial |
$315.40
|
| Rate for Payer: Humana Commercial |
$282.20
|
| Rate for Payer: Humana KY Medicaid |
$114.17
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$115.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$272.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$292.16
|
| Rate for Payer: Ohio Health Group HMO |
$249.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.92
|
| Rate for Payer: PHCS Commercial |
$318.72
|
| Rate for Payer: United Healthcare All Payer |
$292.16
|
|
