|
EMEND 5MG(125 PO LIQ)
|
Facility
|
OP
|
$511.83
|
|
|
Service Code
|
HCPCS J8501
|
| Hospital Charge Code |
25004515
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.55 |
| Max. Negotiated Rate |
$491.36 |
| Rate for Payer: Aetna Commercial |
$394.11
|
| Rate for Payer: Anthem Medicaid |
$176.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$399.23
|
| Rate for Payer: Cash Price |
$255.92
|
| Rate for Payer: Cigna Commercial |
$424.82
|
| Rate for Payer: First Health Commercial |
$486.24
|
| Rate for Payer: Humana Commercial |
$435.06
|
| Rate for Payer: Humana KY Medicaid |
$176.02
|
| Rate for Payer: Kentucky WC Medicaid |
$177.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$450.41
|
| Rate for Payer: Ohio Health Group HMO |
$383.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$353.16
|
| Rate for Payer: PHCS Commercial |
$491.36
|
| Rate for Payer: United Healthcare All Payer |
$450.41
|
|
|
EMG 1 EXTREMITY
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
EMG 1 EXTREMITY
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.32 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$124.62
|
| Rate for Payer: Ambetter Exchange |
$100.50
|
| Rate for Payer: Anthem Medicaid |
$59.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.60
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$133.14
|
| Rate for Payer: Healthspan PPO |
$109.77
|
| Rate for Payer: Humana Medicaid |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.78
|
| Rate for Payer: Molina Healthcare Passport |
$59.59
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.65
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.50
|
|
|
EMG 1 EXTREMITY
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
92200001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
EMG 1 EXTREMITY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
922P0001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$133.14 |
| Rate for Payer: Aetna Commercial |
$124.62
|
| Rate for Payer: Ambetter Exchange |
$100.50
|
| Rate for Payer: Anthem Medicaid |
$59.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.60
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$133.14
|
| Rate for Payer: Healthspan PPO |
$109.77
|
| Rate for Payer: Humana Medicaid |
$59.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.78
|
| Rate for Payer: Molina Healthcare Passport |
$59.59
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.65
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.50
|
|
|
EMG 1 EXTREMITY(T
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
922T0001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem Medicaid |
$61.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Humana KY Medicaid |
$61.90
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
EMG 1 EXTREMITY(T
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
HCPCS 95860
|
| Hospital Charge Code |
922T0001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$140.40
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$149.40
|
| Rate for Payer: First Health Commercial |
$171.00
|
| Rate for Payer: Humana Commercial |
$153.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$147.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$132.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$158.40
|
| Rate for Payer: Ohio Health Group HMO |
$135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.20
|
| Rate for Payer: PHCS Commercial |
$172.80
|
| Rate for Payer: United Healthcare All Payer |
$158.40
|
|
|
EMG 2 EXTREMITIES
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
92200002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$94.71 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$182.19
|
| Rate for Payer: Ambetter Exchange |
$140.85
|
| Rate for Payer: Anthem Medicaid |
$101.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.02
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$175.50
|
| Rate for Payer: Healthspan PPO |
$160.47
|
| Rate for Payer: Humana Medicaid |
$101.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.96
|
| Rate for Payer: Molina Healthcare Passport |
$101.92
|
| Rate for Payer: Multiplan PHCS |
$216.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.10
|
| Rate for Payer: UHCCP Medicaid |
$126.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.85
|
|
|
EMG 2 EXTREMITIES
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
92200002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$346.56 |
| Rate for Payer: Aetna Commercial |
$277.97
|
| Rate for Payer: Anthem Medicaid |
$124.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$299.63
|
| Rate for Payer: First Health Commercial |
$342.95
|
| Rate for Payer: Humana Commercial |
$306.85
|
| Rate for Payer: Humana KY Medicaid |
$124.15
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$125.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.68
|
| Rate for Payer: Ohio Health Group HMO |
$270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.09
|
| Rate for Payer: PHCS Commercial |
$346.56
|
| Rate for Payer: United Healthcare All Payer |
$317.68
|
|
|
EMG 2 EXTREMITIES
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
92200002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$108.30 |
| Max. Negotiated Rate |
$346.56 |
| Rate for Payer: Aetna Commercial |
$277.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$281.58
|
| Rate for Payer: Cash Price |
$180.50
|
| Rate for Payer: Cigna Commercial |
$299.63
|
| Rate for Payer: First Health Commercial |
$342.95
|
| Rate for Payer: Humana Commercial |
$306.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$296.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$266.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$317.68
|
| Rate for Payer: Ohio Health Group HMO |
$270.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$314.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.09
|
| Rate for Payer: PHCS Commercial |
$346.56
|
| Rate for Payer: United Healthcare All Payer |
$317.68
|
|
|
EMG 2 EXTREMITIES(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
922P0002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$183.10 |
| Rate for Payer: Aetna Commercial |
$182.19
|
| Rate for Payer: Ambetter Exchange |
$140.85
|
| Rate for Payer: Anthem Medicaid |
$101.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$140.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$140.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$169.02
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$175.50
|
| Rate for Payer: Healthspan PPO |
$160.47
|
| Rate for Payer: Humana Medicaid |
$101.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$140.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$103.96
|
| Rate for Payer: Molina Healthcare Passport |
$101.92
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$183.10
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$102.94
|
| Rate for Payer: Wellcare Medicare Advantage |
$140.85
|
|
|
EMG 2 EXTREMITIES(T
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
922T0002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$62.25 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem Medicaid |
$62.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Humana KY Medicaid |
$62.25
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
EMG 2 EXTREMITIES(T
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
HCPCS 95861
|
| Hospital Charge Code |
922T0002
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$54.30 |
| Max. Negotiated Rate |
$173.76 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.18
|
| Rate for Payer: Cash Price |
$90.50
|
| Rate for Payer: Cigna Commercial |
$150.23
|
| Rate for Payer: First Health Commercial |
$171.95
|
| Rate for Payer: Humana Commercial |
$153.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.28
|
| Rate for Payer: Ohio Health Group HMO |
$135.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$144.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.89
|
| Rate for Payer: PHCS Commercial |
$173.76
|
| Rate for Payer: United Healthcare All Payer |
$159.28
|
|
|
EMG 3 EXTREMITIES
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
HCPCS 95863
|
| Hospital Charge Code |
92200003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem Medicaid |
$173.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Humana KY Medicaid |
$173.33
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$175.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.76
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
EMG 3 EXTREMITIES
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
HCPCS 95863
|
| Hospital Charge Code |
92200003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$483.84 |
| Rate for Payer: Aetna Commercial |
$388.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.12
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$418.32
|
| Rate for Payer: First Health Commercial |
$478.80
|
| Rate for Payer: Humana Commercial |
$428.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.52
|
| Rate for Payer: Ohio Health Group HMO |
$378.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$347.76
|
| Rate for Payer: PHCS Commercial |
$483.84
|
| Rate for Payer: United Healthcare All Payer |
$443.52
|
|
|
EMG 3 EXTREMITIES
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 95863
|
| Hospital Charge Code |
92200003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$113.94 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$217.12
|
| Rate for Payer: Ambetter Exchange |
$190.76
|
| Rate for Payer: Anthem Medicaid |
$120.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.91
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna Commercial |
$211.79
|
| Rate for Payer: Healthspan PPO |
$191.24
|
| Rate for Payer: Humana Medicaid |
$120.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.36
|
| Rate for Payer: Molina Healthcare Passport |
$120.94
|
| Rate for Payer: Multiplan PHCS |
$302.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.99
|
| Rate for Payer: UHCCP Medicaid |
$176.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.76
|
|
|
EMG 3 EXTREMITIES(P
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 95863
|
| Hospital Charge Code |
922P0003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$247.99 |
| Rate for Payer: Aetna Commercial |
$217.12
|
| Rate for Payer: Ambetter Exchange |
$190.76
|
| Rate for Payer: Anthem Medicaid |
$120.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$190.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$190.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$228.91
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$211.79
|
| Rate for Payer: Healthspan PPO |
$191.24
|
| Rate for Payer: Humana Medicaid |
$120.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$113.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$190.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$123.36
|
| Rate for Payer: Molina Healthcare Passport |
$120.94
|
| Rate for Payer: Multiplan PHCS |
$122.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$247.99
|
| Rate for Payer: UHCCP Medicaid |
$71.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$122.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$190.76
|
|
|
EMG 3 EXTREMITIES(T
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 95863
|
| Hospital Charge Code |
922T0003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
EMG 3 EXTREMITIES(T
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 95863
|
| Hospital Charge Code |
922T0003
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
EMG 4 EXTREMITIES
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 95864
|
| Hospital Charge Code |
92200004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$360.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
EMG 4 EXTREMITIES
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS 95864
|
| Hospital Charge Code |
92200004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$828.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
EMG 4 EXTREMITIES
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 95864
|
| Hospital Charge Code |
92200004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$249.73
|
| Rate for Payer: Ambetter Exchange |
$201.75
|
| Rate for Payer: Anthem Medicaid |
$157.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.10
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$263.78
|
| Rate for Payer: Healthspan PPO |
$219.96
|
| Rate for Payer: Humana Medicaid |
$157.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$201.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.64
|
| Rate for Payer: Molina Healthcare Passport |
$157.49
|
| Rate for Payer: Multiplan PHCS |
$720.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.27
|
| Rate for Payer: UHCCP Medicaid |
$420.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.75
|
|
|
EMG 4 EXTREMITIES(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 95864
|
| Hospital Charge Code |
922P0004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$263.78 |
| Rate for Payer: Aetna Commercial |
$249.73
|
| Rate for Payer: Ambetter Exchange |
$201.75
|
| Rate for Payer: Anthem Medicaid |
$157.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$201.75
|
| Rate for Payer: Buckeye Medicare Advantage |
$201.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$242.10
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$263.78
|
| Rate for Payer: Healthspan PPO |
$219.96
|
| Rate for Payer: Humana Medicaid |
$157.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$201.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$160.64
|
| Rate for Payer: Molina Healthcare Passport |
$157.49
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$262.27
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$159.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$201.75
|
|
|
EMG 4 EXTREMITIES(T
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 95864
|
| Hospital Charge Code |
922T0004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$144.57 |
| 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 |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| 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 |
$144.57
|
| 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 |
$173.48
|
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
EMG 4 EXTREMITIES(T
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 95864
|
| Hospital Charge Code |
922T0004
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$240.00 |
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
