|
UPPER EXT VEIN HARVEST 1 SEG
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 35500
|
| Hospital Charge Code |
76101391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.53
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
UPPER EXT VEIN HARVEST 1 SEG
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 35500
|
| Hospital Charge Code |
76101391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.19 |
| Max. Negotiated Rate |
$577.11 |
| Rate for Payer: Aetna Commercial |
$577.11
|
| Rate for Payer: Ambetter Exchange |
$298.49
|
| Rate for Payer: Anthem Medicaid |
$210.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$298.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$358.19
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$545.11
|
| Rate for Payer: Healthspan PPO |
$567.41
|
| Rate for Payer: Humana Medicaid |
$210.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$441.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$298.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.39
|
| Rate for Payer: Molina Healthcare Passport |
$210.19
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.04
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$298.49
|
|
|
UPPER EXT VEIN HARVEST 1 SEG(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 35500
|
| Hospital Charge Code |
761P1391
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$210.19 |
| Max. Negotiated Rate |
$577.11 |
| Rate for Payer: Aetna Commercial |
$577.11
|
| Rate for Payer: Ambetter Exchange |
$298.49
|
| Rate for Payer: Anthem Medicaid |
$210.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$298.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$298.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$358.19
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$545.11
|
| Rate for Payer: Healthspan PPO |
$567.41
|
| Rate for Payer: Humana Medicaid |
$210.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$441.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$298.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$214.39
|
| Rate for Payer: Molina Healthcare Passport |
$210.19
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$388.04
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$212.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$298.49
|
|
|
UPPER GASTROINTESTINAL ENDO/BX
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
761P1738
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: Aetna Commercial |
$261.64
|
| Rate for Payer: Ambetter Exchange |
$128.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$139.81
|
| Rate for Payer: Anthem Medicaid |
$179.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.61
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$235.94
|
| Rate for Payer: Healthspan PPO |
$417.88
|
| Rate for Payer: Humana Medicaid |
$179.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.80
|
| Rate for Payer: Molina Healthcare Passport |
$179.22
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.49
|
| Rate for Payer: UHCCP Medicaid |
$146.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.84
|
|
|
UPPER GASTROINTESTINAL ENDO/BX
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
76101738
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
UPPER GASTROINTESTINAL ENDO/BX
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
76101738
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.15 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.15
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$379.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
UPPER GASTROINTESTINAL ENDO/BX
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
76101738
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: Aetna Commercial |
$261.64
|
| Rate for Payer: Ambetter Exchange |
$128.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$139.81
|
| Rate for Payer: Anthem Medicaid |
$179.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.61
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$235.94
|
| Rate for Payer: Healthspan PPO |
$417.88
|
| Rate for Payer: Humana Medicaid |
$179.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$223.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$182.80
|
| Rate for Payer: Molina Healthcare Passport |
$179.22
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.49
|
| Rate for Payer: UHCCP Medicaid |
$146.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$181.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.84
|
|
|
Upper Lip Laser Hair Removal
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
22200179
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
Upper Lip Laser Hair Removal
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
22200179
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
Upper Lip Laser Hair Removal
|
Professional
|
Both
|
$100.00
|
|
| Hospital Charge Code |
22200179
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
|
|
Upper Lip LsrHairRem-PP#1 50%
|
Professional
|
Both
|
$129.00
|
|
| Hospital Charge Code |
22200343
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$90.30 |
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Multiplan PHCS |
$77.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.30
|
| Rate for Payer: UHCCP Medicaid |
$45.15
|
|
|
UPPR GI SCOPE W/SUBMUC INJ
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
76101737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$277.50 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$277.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
UPPR GI SCOPE W/SUBMUC INJ
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
76101737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Ambetter Exchange |
$128.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$139.12
|
| Rate for Payer: Anthem Medicaid |
$208.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.61
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$240.51
|
| Rate for Payer: Healthspan PPO |
$448.15
|
| Rate for Payer: Humana Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$229.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.61
|
| Rate for Payer: Molina Healthcare Passport |
$208.44
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.49
|
| Rate for Payer: UHCCP Medicaid |
$146.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.84
|
|
|
UPPR GI SCOPE W/SUBMUC INJ
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
76101737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$318.11 |
| Max. Negotiated Rate |
$1,212.81 |
| Rate for Payer: Aetna Commercial |
$712.25
|
| Rate for Payer: Anthem Medicaid |
$318.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$866.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$721.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,212.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,169.49
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$767.75
|
| Rate for Payer: First Health Commercial |
$878.75
|
| Rate for Payer: Humana Commercial |
$786.25
|
| Rate for Payer: Humana KY Medicaid |
$318.11
|
| Rate for Payer: Humana Medicare Advantage |
$866.29
|
| Rate for Payer: Kentucky WC Medicaid |
$321.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$758.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$682.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,039.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$324.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$814.00
|
| Rate for Payer: Ohio Health Group HMO |
$693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$740.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$804.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.25
|
| Rate for Payer: PHCS Commercial |
$888.00
|
| Rate for Payer: United Healthcare All Payer |
$814.00
|
|
|
UPPR GI SCOPE W/SUBMUC INJ(P
|
Professional
|
Both
|
$925.00
|
|
|
Service Code
|
HCPCS 43236
|
| Hospital Charge Code |
761P1737
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$555.00 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Ambetter Exchange |
$128.84
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$139.12
|
| Rate for Payer: Anthem Medicaid |
$208.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$128.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$128.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.61
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cash Price |
$462.50
|
| Rate for Payer: Cigna Commercial |
$240.51
|
| Rate for Payer: Healthspan PPO |
$448.15
|
| Rate for Payer: Humana Medicaid |
$208.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$229.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$128.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$212.61
|
| Rate for Payer: Molina Healthcare Passport |
$208.44
|
| Rate for Payer: Multiplan PHCS |
$555.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$167.49
|
| Rate for Payer: UHCCP Medicaid |
$146.08
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$210.52
|
| Rate for Payer: Wellcare Medicare Advantage |
$128.84
|
|
|
Uppr Lip LsrHairRem-PP#2/3 25%
|
Professional
|
Both
|
$63.00
|
|
| Hospital Charge Code |
22200459
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Multiplan PHCS |
$37.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$44.10
|
| Rate for Payer: UHCCP Medicaid |
$22.05
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Professional
|
Both
|
$690.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
92100004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$182.46
|
| Rate for Payer: Ambetter Exchange |
$73.11
|
| Rate for Payer: Anthem Medicaid |
$48.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.73
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$151.98
|
| Rate for Payer: Healthspan PPO |
$194.91
|
| Rate for Payer: Humana Medicaid |
$48.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.95
|
| Rate for Payer: Molina Healthcare Passport |
$48.97
|
| Rate for Payer: Multiplan PHCS |
$414.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.04
|
| Rate for Payer: UHCCP Medicaid |
$241.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.11
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$542.40 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Anthem Medicaid |
$194.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cigna Commercial |
$468.95
|
| Rate for Payer: First Health Commercial |
$536.75
|
| Rate for Payer: Humana Commercial |
$480.25
|
| Rate for Payer: Humana KY Medicaid |
$194.30
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$196.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.20
|
| Rate for Payer: Ohio Health Group HMO |
$423.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$491.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.85
|
| Rate for Payer: PHCS Commercial |
$542.40
|
| Rate for Payer: United Healthcare All Payer |
$497.20
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$690.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
92100004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
92000007
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$542.40 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.70
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cigna Commercial |
$468.95
|
| Rate for Payer: First Health Commercial |
$536.75
|
| Rate for Payer: Humana Commercial |
$480.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.20
|
| Rate for Payer: Ohio Health Group HMO |
$423.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$491.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.85
|
| Rate for Payer: PHCS Commercial |
$542.40
|
| Rate for Payer: United Healthcare All Payer |
$497.20
|
|
|
UPR/L XTREMITY ART 2 LEVELS
|
Facility
|
OP
|
$690.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
92100004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$662.40 |
| Rate for Payer: Aetna Commercial |
$531.30
|
| Rate for Payer: Anthem Medicaid |
$237.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$538.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cash Price |
$345.00
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: First Health Commercial |
$655.50
|
| Rate for Payer: Humana Commercial |
$586.50
|
| Rate for Payer: Humana KY Medicaid |
$237.29
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$239.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$509.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$607.20
|
| Rate for Payer: Ohio Health Group HMO |
$517.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.10
|
| Rate for Payer: PHCS Commercial |
$662.40
|
| Rate for Payer: United Healthcare All Payer |
$607.20
|
|
|
UPR/L XTREMITY ART 2 LEVELS(P
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
921P0004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$16.22 |
| Max. Negotiated Rate |
$194.91 |
| Rate for Payer: Aetna Commercial |
$182.46
|
| Rate for Payer: Ambetter Exchange |
$73.11
|
| Rate for Payer: Anthem Medicaid |
$48.97
|
| Rate for Payer: Buckeye Individual/Medicaid |
$73.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$73.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.73
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cigna Commercial |
$151.98
|
| Rate for Payer: Healthspan PPO |
$194.91
|
| Rate for Payer: Humana Medicaid |
$48.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$73.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.95
|
| Rate for Payer: Molina Healthcare Passport |
$48.97
|
| Rate for Payer: Multiplan PHCS |
$52.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$95.04
|
| Rate for Payer: UHCCP Medicaid |
$30.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$49.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$73.11
|
|
|
UPR/L XTREMITY ART 2 LEVELS(T
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
921T0004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
UPR/L XTREMITY ART 2 LEVELS(T
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 93922
|
| Hospital Charge Code |
921T0004
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
UR ALBUMIN CREATININE POC
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 82044
|
| Hospital Charge Code |
30001936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$48.51
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$50.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.23
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$52.29
|
| Rate for Payer: First Health Commercial |
$59.85
|
| Rate for Payer: Humana Commercial |
$53.55
|
| Rate for Payer: Humana KY Medicaid |
$6.23
|
| Rate for Payer: Humana Medicare Advantage |
$6.23
|
| Rate for Payer: Kentucky WC Medicaid |
$6.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$51.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$46.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$55.44
|
| Rate for Payer: Ohio Health Group HMO |
$47.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.47
|
| Rate for Payer: PHCS Commercial |
$60.48
|
| Rate for Payer: United Healthcare All Payer |
$55.44
|
|
