|
WOLVERINE CUT. BALLOON 4*15
|
Facility
|
OP
|
$4,418.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.44 |
| Max. Negotiated Rate |
$4,241.42 |
| Rate for Payer: Aetna Commercial |
$3,401.98
|
| Rate for Payer: Anthem Medicaid |
$1,519.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,446.16
|
| Rate for Payer: Cash Price |
$2,209.07
|
| Rate for Payer: Cigna Commercial |
$3,667.06
|
| Rate for Payer: First Health Commercial |
$4,197.24
|
| Rate for Payer: Humana Commercial |
$3,755.43
|
| Rate for Payer: Humana KY Medicaid |
$1,519.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,534.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,549.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,534.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,843.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,048.52
|
| Rate for Payer: PHCS Commercial |
$4,241.42
|
| Rate for Payer: United Healthcare All Payer |
$3,887.97
|
|
|
WOLVERINE CUT. BALLOON 4*15
|
Facility
|
IP
|
$4,418.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.44 |
| Max. Negotiated Rate |
$4,241.42 |
| Rate for Payer: Aetna Commercial |
$3,401.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,446.16
|
| Rate for Payer: Cash Price |
$2,209.07
|
| Rate for Payer: Cigna Commercial |
$3,667.06
|
| Rate for Payer: First Health Commercial |
$4,197.24
|
| Rate for Payer: Humana Commercial |
$3,755.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,534.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,843.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,048.52
|
| Rate for Payer: PHCS Commercial |
$4,241.42
|
| Rate for Payer: United Healthcare All Payer |
$3,887.97
|
|
|
WOLVERINE CUT. BALLOON 4*6
|
Facility
|
IP
|
$4,418.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.44 |
| Max. Negotiated Rate |
$4,241.42 |
| Rate for Payer: Aetna Commercial |
$3,401.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,446.16
|
| Rate for Payer: Cash Price |
$2,209.07
|
| Rate for Payer: Cigna Commercial |
$3,667.06
|
| Rate for Payer: First Health Commercial |
$4,197.24
|
| Rate for Payer: Humana Commercial |
$3,755.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,534.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,843.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,048.52
|
| Rate for Payer: PHCS Commercial |
$4,241.42
|
| Rate for Payer: United Healthcare All Payer |
$3,887.97
|
|
|
WOLVERINE CUT. BALLOON 4*6
|
Facility
|
OP
|
$4,418.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,325.44 |
| Max. Negotiated Rate |
$4,241.42 |
| Rate for Payer: Aetna Commercial |
$3,401.98
|
| Rate for Payer: Anthem Medicaid |
$1,519.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,446.16
|
| Rate for Payer: Cash Price |
$2,209.07
|
| Rate for Payer: Cigna Commercial |
$3,667.06
|
| Rate for Payer: First Health Commercial |
$4,197.24
|
| Rate for Payer: Humana Commercial |
$3,755.43
|
| Rate for Payer: Humana KY Medicaid |
$1,519.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,534.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,549.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,534.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,843.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,048.52
|
| Rate for Payer: PHCS Commercial |
$4,241.42
|
| Rate for Payer: United Healthcare All Payer |
$3,887.97
|
|
|
WORK CONDITIONING OT 1ST 2HRS
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS 97545
|
| Hospital Charge Code |
43000027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$102.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$102.48
|
| Rate for Payer: Kentucky WC Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
WORK CONDITIONING OT 1ST 2HRS
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
43000027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem Medicaid |
$102.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Humana KY Medicaid |
$102.48
|
| Rate for Payer: Kentucky WC Medicaid |
$103.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
WORK CONDITIONING OT 1ST 2HRS
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
43000027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
WORK CONDITIONING OT 1ST 2HRS
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
HCPCS 97545
|
| Hospital Charge Code |
43000027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$286.08 |
| Rate for Payer: Aetna Commercial |
$229.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$232.44
|
| Rate for Payer: Cash Price |
$149.00
|
| Rate for Payer: Cigna Commercial |
$247.34
|
| Rate for Payer: First Health Commercial |
$283.10
|
| Rate for Payer: Humana Commercial |
$253.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$244.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$219.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$262.24
|
| Rate for Payer: Ohio Health Group HMO |
$223.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$238.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.62
|
| Rate for Payer: PHCS Commercial |
$286.08
|
| Rate for Payer: United Healthcare All Payer |
$262.24
|
|
|
WORK CONDITIONING PT 1ST 2 HRS
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
WORK CONDITIONING PT 1ST 2 HRS
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS W0710
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem Medicaid |
$105.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Humana KY Medicaid |
$105.23
|
| Rate for Payer: Kentucky WC Medicaid |
$106.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
WORK CONDITIONING PT 1ST 2 HRS
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
HCPCS 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
WORK CONDITIONING PT 1ST 2 HRS
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
HCPCS 97545
|
| Hospital Charge Code |
42000033
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$293.76 |
| Rate for Payer: Aetna Commercial |
$235.62
|
| Rate for Payer: Anthem Medicaid |
$105.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$238.68
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$253.98
|
| Rate for Payer: First Health Commercial |
$290.70
|
| Rate for Payer: Humana Commercial |
$260.10
|
| Rate for Payer: Humana KY Medicaid |
$105.23
|
| Rate for Payer: Kentucky WC Medicaid |
$106.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$107.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$269.28
|
| Rate for Payer: Ohio Health Group HMO |
$229.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$211.14
|
| Rate for Payer: PHCS Commercial |
$293.76
|
| Rate for Payer: United Healthcare All Payer |
$269.28
|
|
|
WORK CONDITIONING PT EA ADD HR
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
WORK CONDITIONING PT EA ADD HR
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
42000034
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$184.32 |
| Rate for Payer: Aetna Commercial |
$147.84
|
| Rate for Payer: Anthem Medicaid |
$66.03
|
| 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: Humana KY Medicaid |
$66.03
|
| 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 |
$57.60
|
| 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
|
|
|
WORK CONDITION OT EA ADDTL HR
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
43000028
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
WORK CONDITION OT EA ADDTL HR
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
HCPCS 97546
|
| Hospital Charge Code |
43000028
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
WORK & OTHER PHYSICALS
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
45000320
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem Medicaid |
$8.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Humana KY Medicaid |
$8.60
|
| Rate for Payer: Kentucky WC Medicaid |
$8.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
WORK & OTHER PHYSICALS
|
Professional
|
Both
|
$25.00
|
|
| Hospital Charge Code |
45000320
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
|
|
WORK & OTHER PHYSICALS
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
45000320
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$19.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: First Health Commercial |
$23.75
|
| Rate for Payer: Humana Commercial |
$21.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22.00
|
| Rate for Payer: Ohio Health Group HMO |
$18.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17.25
|
| Rate for Payer: PHCS Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Payer |
$22.00
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$148.10
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
76102534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$142.18 |
| Rate for Payer: Aetna Commercial |
$114.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.52
|
| Rate for Payer: Cash Price |
$74.05
|
| Rate for Payer: Cigna Commercial |
$122.92
|
| Rate for Payer: First Health Commercial |
$140.69
|
| Rate for Payer: Humana Commercial |
$125.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.33
|
| Rate for Payer: Ohio Health Group HMO |
$111.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.19
|
| Rate for Payer: PHCS Commercial |
$142.18
|
| Rate for Payer: United Healthcare All Payer |
$130.33
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$148.10
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
76102534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$142.18 |
| Rate for Payer: Aetna Commercial |
$114.04
|
| Rate for Payer: Anthem Medicaid |
$50.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$115.52
|
| Rate for Payer: Cash Price |
$74.05
|
| Rate for Payer: Cigna Commercial |
$122.92
|
| Rate for Payer: First Health Commercial |
$140.69
|
| Rate for Payer: Humana Commercial |
$125.89
|
| Rate for Payer: Humana KY Medicaid |
$50.93
|
| Rate for Payer: Kentucky WC Medicaid |
$51.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$121.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$109.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$130.33
|
| Rate for Payer: Ohio Health Group HMO |
$111.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$128.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$102.19
|
| Rate for Payer: PHCS Commercial |
$142.18
|
| Rate for Payer: United Healthcare All Payer |
$130.33
|
|
|
WOUND EXPLORATION ABDOMEN
|
Professional
|
Both
|
$6,861.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.35 |
| Max. Negotiated Rate |
$4,116.60 |
| Rate for Payer: Aetna Commercial |
$365.13
|
| Rate for Payer: Ambetter Exchange |
$243.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.35
|
| Rate for Payer: Anthem Medicaid |
$170.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$243.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$243.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$291.90
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cigna Commercial |
$386.13
|
| Rate for Payer: Healthspan PPO |
$578.94
|
| Rate for Payer: Humana Medicaid |
$170.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$315.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$243.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.83
|
| Rate for Payer: Molina Healthcare Passport |
$170.42
|
| Rate for Payer: Multiplan PHCS |
$4,116.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$316.23
|
| Rate for Payer: UHCCP Medicaid |
$141.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$243.25
|
|
|
WOUND EXPLORATION ABDOMEN
|
Facility
|
IP
|
$6,861.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,058.30 |
| Max. Negotiated Rate |
$6,586.56 |
| Rate for Payer: Aetna Commercial |
$5,282.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,351.58
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cigna Commercial |
$5,694.63
|
| Rate for Payer: First Health Commercial |
$6,517.95
|
| Rate for Payer: Humana Commercial |
$5,831.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,626.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,063.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,058.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,037.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,145.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,969.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,734.09
|
| Rate for Payer: PHCS Commercial |
$6,586.56
|
| Rate for Payer: United Healthcare All Payer |
$6,037.68
|
|
|
WOUND EXPLORATION ABDOMEN
|
Facility
|
OP
|
$6,861.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
76100324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,690.17 |
| Max. Negotiated Rate |
$6,586.56 |
| Rate for Payer: Aetna Commercial |
$5,282.97
|
| Rate for Payer: Anthem Medicaid |
$2,359.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,690.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,351.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,366.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,281.73
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cash Price |
$3,430.50
|
| Rate for Payer: Cigna Commercial |
$5,694.63
|
| Rate for Payer: First Health Commercial |
$6,517.95
|
| Rate for Payer: Humana Commercial |
$5,831.85
|
| Rate for Payer: Humana KY Medicaid |
$2,359.50
|
| Rate for Payer: Humana Medicare Advantage |
$1,690.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,383.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,626.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,063.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,037.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,145.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,488.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,969.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,734.09
|
| Rate for Payer: PHCS Commercial |
$6,586.56
|
| Rate for Payer: United Healthcare All Payer |
$6,037.68
|
|
|
WOUND EXPLORATION ABDOMEN(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 20102
|
| Hospital Charge Code |
761P0324
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$134.35 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Aetna Commercial |
$365.13
|
| Rate for Payer: Ambetter Exchange |
$243.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$134.35
|
| Rate for Payer: Anthem Medicaid |
$170.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$243.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$243.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$291.90
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$386.13
|
| Rate for Payer: Healthspan PPO |
$578.94
|
| Rate for Payer: Humana Medicaid |
$170.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$315.18
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$243.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$173.83
|
| Rate for Payer: Molina Healthcare Passport |
$170.42
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$316.23
|
| Rate for Payer: UHCCP Medicaid |
$141.07
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$172.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$243.25
|
|
