|
HEARING AID REPAIR MINOR
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
47000051
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
HEARING AID REPAIR MINOR
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
47000039
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
HEARING AID REPAIR MINOR
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
47000053
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
HEARING AID REPAIR MINOR
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
47000052
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$173.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$175.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$186.75
|
| Rate for Payer: First Health Commercial |
$213.75
|
| Rate for Payer: Humana Commercial |
$191.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$184.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.00
|
| Rate for Payer: Ohio Health Group HMO |
$168.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$195.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.25
|
| Rate for Payer: PHCS Commercial |
$216.00
|
| Rate for Payer: United Healthcare All Payer |
$198.00
|
|
|
HEARING AID REPAIR MINOR
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
47000051
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Anthem Medicaid |
$25.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$62.25
|
| Rate for Payer: First Health Commercial |
$71.25
|
| Rate for Payer: Humana Commercial |
$63.75
|
| Rate for Payer: Humana KY Medicaid |
$25.79
|
| Rate for Payer: Kentucky WC Medicaid |
$26.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$61.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$55.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$66.00
|
| Rate for Payer: Ohio Health Group HMO |
$56.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.75
|
| Rate for Payer: PHCS Commercial |
$72.00
|
| Rate for Payer: United Healthcare All Payer |
$66.00
|
|
|
HEARING AID REPAIR MINOR
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
47000053
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.97
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
HEARING AID REPAIR MINOR
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
47000039
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem Medicaid |
$120.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Humana KY Medicaid |
$120.36
|
| Rate for Payer: Kentucky WC Medicaid |
$121.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
HEARING AID REPAIR/MINOR
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS V5014
|
| Hospital Charge Code |
47000063
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Anthem Medicaid |
$9.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.06
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$22.41
|
| Rate for Payer: First Health Commercial |
$25.65
|
| Rate for Payer: Humana Commercial |
$22.95
|
| Rate for Payer: Humana KY Medicaid |
$9.29
|
| Rate for Payer: Kentucky WC Medicaid |
$9.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.76
|
| Rate for Payer: Ohio Health Group HMO |
$20.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$25.92
|
| Rate for Payer: United Healthcare All Payer |
$23.76
|
|
|
HEARING AID REPAIR/MINOR
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS V5014
|
| Hospital Charge Code |
47000063
|
|
Hospital Revenue Code
|
292
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$25.92 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21.06
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$22.41
|
| Rate for Payer: First Health Commercial |
$25.65
|
| Rate for Payer: Humana Commercial |
$22.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$23.76
|
| Rate for Payer: Ohio Health Group HMO |
$20.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.63
|
| Rate for Payer: PHCS Commercial |
$25.92
|
| Rate for Payer: United Healthcare All Payer |
$23.76
|
|
|
HEARING AID REPAIR MINOR SP
|
Professional
|
Both
|
$99.00
|
|
| Hospital Charge Code |
47000114
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$34.65 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Multiplan PHCS |
$59.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.30
|
| Rate for Payer: UHCCP Medicaid |
$34.65
|
|
|
HEART FIRST PASS ADD-ON
|
Facility
|
OP
|
$1,053.05
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
34000079
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$315.92 |
| Max. Negotiated Rate |
$1,010.93 |
| Rate for Payer: Aetna Commercial |
$810.85
|
| Rate for Payer: Anthem Medicaid |
$362.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$821.38
|
| Rate for Payer: Cash Price |
$526.52
|
| Rate for Payer: Cigna Commercial |
$874.03
|
| Rate for Payer: First Health Commercial |
$1,000.40
|
| Rate for Payer: Humana Commercial |
$895.09
|
| Rate for Payer: Humana KY Medicaid |
$362.14
|
| Rate for Payer: Kentucky WC Medicaid |
$365.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$863.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$777.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$369.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$926.68
|
| Rate for Payer: Ohio Health Group HMO |
$789.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$726.60
|
| Rate for Payer: PHCS Commercial |
$1,010.93
|
| Rate for Payer: United Healthcare All Payer |
$926.68
|
|
|
HEART FIRST PASS ADD-ON
|
Facility
|
IP
|
$1,053.05
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
34000079
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$315.92 |
| Max. Negotiated Rate |
$1,010.93 |
| Rate for Payer: Aetna Commercial |
$810.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$821.38
|
| Rate for Payer: Cash Price |
$526.52
|
| Rate for Payer: Cigna Commercial |
$874.03
|
| Rate for Payer: First Health Commercial |
$1,000.40
|
| Rate for Payer: Humana Commercial |
$895.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$863.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$777.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$926.68
|
| Rate for Payer: Ohio Health Group HMO |
$789.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$916.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$726.60
|
| Rate for Payer: PHCS Commercial |
$1,010.93
|
| Rate for Payer: United Healthcare All Payer |
$926.68
|
|
|
HEART FIRST PASS ADD-ON
|
Professional
|
Both
|
$1,053.05
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
34000079
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$631.83 |
| Rate for Payer: Aetna Commercial |
$183.82
|
| Rate for Payer: Ambetter Exchange |
$38.06
|
| Rate for Payer: Anthem Medicaid |
$34.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.67
|
| Rate for Payer: Cash Price |
$526.52
|
| Rate for Payer: Cash Price |
$526.52
|
| Rate for Payer: Cigna Commercial |
$357.36
|
| Rate for Payer: Healthspan PPO |
$183.73
|
| Rate for Payer: Humana Medicaid |
$34.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.19
|
| Rate for Payer: Molina Healthcare Passport |
$34.50
|
| Rate for Payer: Multiplan PHCS |
$631.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.48
|
| Rate for Payer: UHCCP Medicaid |
$368.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.06
|
|
|
HEART FIRST PASS ADD-ON(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
340P0079
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$357.36 |
| Rate for Payer: Aetna Commercial |
$183.82
|
| Rate for Payer: Ambetter Exchange |
$38.06
|
| Rate for Payer: Anthem Medicaid |
$34.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$38.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$38.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$45.67
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$357.36
|
| Rate for Payer: Healthspan PPO |
$183.73
|
| Rate for Payer: Humana Medicaid |
$34.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$38.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.19
|
| Rate for Payer: Molina Healthcare Passport |
$34.50
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.48
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.84
|
| Rate for Payer: Wellcare Medicare Advantage |
$38.06
|
|
|
HEART FIRST PASS ADD-ON(T
|
Facility
|
IP
|
$1,003.05
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
340T0079
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$300.92 |
| Max. Negotiated Rate |
$962.93 |
| Rate for Payer: Aetna Commercial |
$772.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.38
|
| Rate for Payer: Cash Price |
$501.52
|
| Rate for Payer: Cigna Commercial |
$832.53
|
| Rate for Payer: First Health Commercial |
$952.90
|
| Rate for Payer: Humana Commercial |
$852.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.68
|
| Rate for Payer: Ohio Health Group HMO |
$752.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.10
|
| Rate for Payer: PHCS Commercial |
$962.93
|
| Rate for Payer: United Healthcare All Payer |
$882.68
|
|
|
HEART FIRST PASS ADD-ON(T
|
Facility
|
OP
|
$1,003.05
|
|
|
Service Code
|
HCPCS 78496
|
| Hospital Charge Code |
340T0079
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$300.92 |
| Max. Negotiated Rate |
$962.93 |
| Rate for Payer: Aetna Commercial |
$772.35
|
| Rate for Payer: Anthem Medicaid |
$344.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$782.38
|
| Rate for Payer: Cash Price |
$501.52
|
| Rate for Payer: Cigna Commercial |
$832.53
|
| Rate for Payer: First Health Commercial |
$952.90
|
| Rate for Payer: Humana Commercial |
$852.59
|
| Rate for Payer: Humana KY Medicaid |
$344.95
|
| Rate for Payer: Kentucky WC Medicaid |
$348.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$822.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$740.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$351.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$882.68
|
| Rate for Payer: Ohio Health Group HMO |
$752.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$802.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$872.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$692.10
|
| Rate for Payer: PHCS Commercial |
$962.93
|
| Rate for Payer: United Healthcare All Payer |
$882.68
|
|
|
HEART INFARCT IMAGE (3D)
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
34000078
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$1,413.60 |
| Rate for Payer: Aetna Commercial |
$388.26
|
| Rate for Payer: Ambetter Exchange |
$183.31
|
| Rate for Payer: Anthem Medicaid |
$180.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.97
|
| Rate for Payer: Cash Price |
$1,178.00
|
| Rate for Payer: Cash Price |
$1,178.00
|
| Rate for Payer: Cigna Commercial |
$380.89
|
| Rate for Payer: Healthspan PPO |
$388.06
|
| Rate for Payer: Humana Medicaid |
$180.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.42
|
| Rate for Payer: Molina Healthcare Passport |
$180.80
|
| Rate for Payer: Multiplan PHCS |
$1,413.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.30
|
| Rate for Payer: UHCCP Medicaid |
$824.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.31
|
|
|
HEART INFARCT IMAGE (3D)
|
Facility
|
OP
|
$2,356.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
34000078
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$2,261.76 |
| Rate for Payer: Aetna Commercial |
$1,814.12
|
| Rate for Payer: Anthem Medicaid |
$810.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,837.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,178.00
|
| Rate for Payer: Cash Price |
$1,178.00
|
| Rate for Payer: Cigna Commercial |
$1,955.48
|
| Rate for Payer: First Health Commercial |
$2,238.20
|
| Rate for Payer: Humana Commercial |
$2,002.60
|
| Rate for Payer: Humana KY Medicaid |
$810.23
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$818.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,931.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,738.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$826.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,073.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,767.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,049.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,625.64
|
| Rate for Payer: PHCS Commercial |
$2,261.76
|
| Rate for Payer: United Healthcare All Payer |
$2,073.28
|
|
|
HEART INFARCT IMAGE (3D)
|
Facility
|
IP
|
$2,356.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
34000078
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$706.80 |
| Max. Negotiated Rate |
$2,261.76 |
| Rate for Payer: Aetna Commercial |
$1,814.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,837.68
|
| Rate for Payer: Cash Price |
$1,178.00
|
| Rate for Payer: Cigna Commercial |
$1,955.48
|
| Rate for Payer: First Health Commercial |
$2,238.20
|
| Rate for Payer: Humana Commercial |
$2,002.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,931.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,738.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$706.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,073.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,767.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,884.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,049.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,625.64
|
| Rate for Payer: PHCS Commercial |
$2,261.76
|
| Rate for Payer: United Healthcare All Payer |
$2,073.28
|
|
|
HEART INFARCT IMAGE (3D)(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
340P0078
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$388.26 |
| Rate for Payer: Aetna Commercial |
$388.26
|
| Rate for Payer: Ambetter Exchange |
$183.31
|
| Rate for Payer: Anthem Medicaid |
$180.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$183.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$183.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$219.97
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$380.89
|
| Rate for Payer: Healthspan PPO |
$388.06
|
| Rate for Payer: Humana Medicaid |
$180.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$53.55
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$183.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$184.42
|
| Rate for Payer: Molina Healthcare Passport |
$180.80
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.30
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$182.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$183.31
|
|
|
HEART INFARCT IMAGE (3D)(T
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
340T0078
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$2,194.56 |
| Rate for Payer: Aetna Commercial |
$1,760.22
|
| Rate for Payer: Anthem Medicaid |
$786.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$497.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,783.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$696.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$671.42
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cigna Commercial |
$1,897.38
|
| Rate for Payer: First Health Commercial |
$2,171.70
|
| Rate for Payer: Humana Commercial |
$1,943.10
|
| Rate for Payer: Humana KY Medicaid |
$786.16
|
| Rate for Payer: Humana Medicare Advantage |
$497.35
|
| Rate for Payer: Kentucky WC Medicaid |
$794.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,874.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,687.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$801.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,011.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,714.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,988.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.34
|
| Rate for Payer: PHCS Commercial |
$2,194.56
|
| Rate for Payer: United Healthcare All Payer |
$2,011.68
|
|
|
HEART INFARCT IMAGE (3D)(T
|
Facility
|
IP
|
$2,286.00
|
|
|
Service Code
|
HCPCS 78469
|
| Hospital Charge Code |
340T0078
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$685.80 |
| Max. Negotiated Rate |
$2,194.56 |
| Rate for Payer: Aetna Commercial |
$1,760.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,783.08
|
| Rate for Payer: Cash Price |
$1,143.00
|
| Rate for Payer: Cigna Commercial |
$1,897.38
|
| Rate for Payer: First Health Commercial |
$2,171.70
|
| Rate for Payer: Humana Commercial |
$1,943.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,874.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,687.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$685.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,011.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,714.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,828.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,988.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.34
|
| Rate for Payer: PHCS Commercial |
$2,194.56
|
| Rate for Payer: United Healthcare All Payer |
$2,011.68
|
|
|
HEART/LUNG RESUSCITATION CP(P
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
410P0066
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$454.49 |
| Rate for Payer: Aetna Commercial |
$297.88
|
| Rate for Payer: Ambetter Exchange |
$173.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.27
|
| Rate for Payer: Anthem Medicaid |
$176.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$173.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.72
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$454.49
|
| Rate for Payer: Healthspan PPO |
$416.30
|
| Rate for Payer: Humana Medicaid |
$176.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$173.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.05
|
| Rate for Payer: Molina Healthcare Passport |
$176.52
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$225.03
|
| Rate for Payer: UHCCP Medicaid |
$97.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.10
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
41000066
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$255.60 |
| Max. Negotiated Rate |
$817.92 |
| Rate for Payer: Aetna Commercial |
$656.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$664.56
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$707.16
|
| Rate for Payer: First Health Commercial |
$809.40
|
| Rate for Payer: Humana Commercial |
$724.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$698.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$749.76
|
| Rate for Payer: Ohio Health Group HMO |
$639.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$741.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.88
|
| Rate for Payer: PHCS Commercial |
$817.92
|
| Rate for Payer: United Healthcare All Payer |
$749.76
|
|
|
HEART/LUNG RESUSCITATION CPR
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 92950
|
| Hospital Charge Code |
41000066
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$93.27 |
| Max. Negotiated Rate |
$511.20 |
| Rate for Payer: Aetna Commercial |
$297.88
|
| Rate for Payer: Ambetter Exchange |
$173.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$93.27
|
| Rate for Payer: Anthem Medicaid |
$176.52
|
| Rate for Payer: Buckeye Individual/Medicaid |
$173.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$173.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$207.72
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cash Price |
$426.00
|
| Rate for Payer: Cigna Commercial |
$454.49
|
| Rate for Payer: Healthspan PPO |
$416.30
|
| Rate for Payer: Humana Medicaid |
$176.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$234.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$173.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.05
|
| Rate for Payer: Molina Healthcare Passport |
$176.52
|
| Rate for Payer: Multiplan PHCS |
$511.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$225.03
|
| Rate for Payer: UHCCP Medicaid |
$97.93
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$173.10
|
|
