|
INTRAABDOMINAL PRESSURE TES(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
320P0265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$400.70 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Ambetter Exchange |
$149.33
|
| Rate for Payer: Anthem Medicaid |
$75.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.20
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$400.70
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$75.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.63
|
| Rate for Payer: Molina Healthcare Passport |
$75.13
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.13
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.33
|
|
|
INTRAABDOMINAL PRESSURE TES(T
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
320T0265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
INTRAABDOMINAL PRESSURE TES(T
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
320T0265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$159.30 |
| Max. Negotiated Rate |
$509.76 |
| Rate for Payer: Aetna Commercial |
$408.87
|
| Rate for Payer: Anthem Medicaid |
$182.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$414.18
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$440.73
|
| Rate for Payer: First Health Commercial |
$504.45
|
| Rate for Payer: Humana Commercial |
$451.35
|
| Rate for Payer: Humana KY Medicaid |
$182.61
|
| Rate for Payer: Kentucky WC Medicaid |
$184.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$435.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$391.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$186.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$467.28
|
| Rate for Payer: Ohio Health Group HMO |
$398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$366.39
|
| Rate for Payer: PHCS Commercial |
$509.76
|
| Rate for Payer: United Healthcare All Payer |
$467.28
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
IP
|
$681.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$204.30 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$524.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.18
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$565.23
|
| Rate for Payer: First Health Commercial |
$646.95
|
| Rate for Payer: Humana Commercial |
$578.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$558.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$502.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$599.28
|
| Rate for Payer: Ohio Health Group HMO |
$510.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.89
|
| Rate for Payer: PHCS Commercial |
$653.76
|
| Rate for Payer: United Healthcare All Payer |
$599.28
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$408.60 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Ambetter Exchange |
$149.33
|
| Rate for Payer: Anthem Medicaid |
$75.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.20
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$400.70
|
| Rate for Payer: Healthspan PPO |
$186.11
|
| Rate for Payer: Humana Medicaid |
$75.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.39
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.63
|
| Rate for Payer: Molina Healthcare Passport |
$75.13
|
| Rate for Payer: Multiplan PHCS |
$408.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.13
|
| Rate for Payer: UHCCP Medicaid |
$238.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.33
|
|
|
INTRAABDOMINAL PRESSURE TEST
|
Facility
|
OP
|
$681.00
|
|
|
Service Code
|
HCPCS 51797
|
| Hospital Charge Code |
32000265
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$204.30 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$524.37
|
| Rate for Payer: Anthem Medicaid |
$234.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$531.18
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$565.23
|
| Rate for Payer: First Health Commercial |
$646.95
|
| Rate for Payer: Humana Commercial |
$578.85
|
| Rate for Payer: Humana KY Medicaid |
$234.20
|
| Rate for Payer: Kentucky WC Medicaid |
$236.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$558.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$502.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$204.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$238.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$599.28
|
| Rate for Payer: Ohio Health Group HMO |
$510.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$592.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.89
|
| Rate for Payer: PHCS Commercial |
$653.76
|
| Rate for Payer: United Healthcare All Payer |
$599.28
|
|
|
INTRACRAN ANGIOPLSTY W/STEN(P
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
761P2287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,298.43 |
| Rate for Payer: Aetna Commercial |
$2,298.43
|
| Rate for Payer: Ambetter Exchange |
$1,425.12
|
| Rate for Payer: Anthem Medicaid |
$1,105.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,425.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,425.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,710.14
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,160.33
|
| Rate for Payer: Healthspan PPO |
$1,794.56
|
| Rate for Payer: Humana Medicaid |
$1,105.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,792.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,425.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,127.96
|
| Rate for Payer: Molina Healthcare Passport |
$1,105.84
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,852.66
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,116.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,425.12
|
|
|
INTRACRAN ANGIOPLSTY W/STENT
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
76102287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,298.43 |
| Rate for Payer: Aetna Commercial |
$2,298.43
|
| Rate for Payer: Ambetter Exchange |
$1,425.12
|
| Rate for Payer: Anthem Medicaid |
$1,105.84
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,425.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,425.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,710.14
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$2,160.33
|
| Rate for Payer: Healthspan PPO |
$1,794.56
|
| Rate for Payer: Humana Medicaid |
$1,105.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,792.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,425.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,127.96
|
| Rate for Payer: Molina Healthcare Passport |
$1,105.84
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,852.66
|
| Rate for Payer: UHCCP Medicaid |
$700.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,116.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,425.12
|
|
|
INTRACRAN ANGIOPLSTY W/STENT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
76102287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
INTRACRAN ANGIOPLSTY W/STENT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
HCPCS 61635
|
| Hospital Charge Code |
76102287
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$1,540.00
|
| Rate for Payer: Anthem Medicaid |
$687.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$1,660.00
|
| Rate for Payer: First Health Commercial |
$1,900.00
|
| Rate for Payer: Humana Commercial |
$1,700.00
|
| Rate for Payer: Humana KY Medicaid |
$687.80
|
| Rate for Payer: Kentucky WC Medicaid |
$694.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,640.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,476.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,760.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,740.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.00
|
| Rate for Payer: PHCS Commercial |
$1,920.00
|
| Rate for Payer: United Healthcare All Payer |
$1,760.00
|
|
|
INTRACRANIAL ANGIOPLASTY
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
76102286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
INTRACRANIAL ANGIOPLASTY
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
76102286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,098.61 |
| Rate for Payer: Aetna Commercial |
$2,098.61
|
| Rate for Payer: Ambetter Exchange |
$1,301.67
|
| Rate for Payer: Anthem Medicaid |
$1,007.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,301.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,301.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,562.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,974.15
|
| Rate for Payer: Healthspan PPO |
$1,638.54
|
| Rate for Payer: Humana Medicaid |
$1,007.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,662.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,301.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,027.82
|
| Rate for Payer: Molina Healthcare Passport |
$1,007.67
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,692.17
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,017.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,301.67
|
|
|
INTRACRANIAL ANGIOPLASTY
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
76102286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
INTRACRANIAL ANGIOPLASTY(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 61630
|
| Hospital Charge Code |
761P2286
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$2,098.61 |
| Rate for Payer: Aetna Commercial |
$2,098.61
|
| Rate for Payer: Ambetter Exchange |
$1,301.67
|
| Rate for Payer: Anthem Medicaid |
$1,007.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,301.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,301.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,562.00
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,974.15
|
| Rate for Payer: Healthspan PPO |
$1,638.54
|
| Rate for Payer: Humana Medicaid |
$1,007.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,662.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,301.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,027.82
|
| Rate for Payer: Molina Healthcare Passport |
$1,007.67
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,692.17
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,017.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,301.67
|
|
|
INTRACRANIAL STUDY
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
INTRACRANIAL STUDY
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem Medicaid |
$363.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Humana KY Medicaid |
$363.50
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
INTRACRANIAL STUDY
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
32000297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$634.20 |
| Rate for Payer: Aetna Commercial |
$145.48
|
| Rate for Payer: Ambetter Exchange |
$144.67
|
| Rate for Payer: Anthem Medicaid |
$105.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.60
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$253.58
|
| Rate for Payer: Healthspan PPO |
$155.40
|
| Rate for Payer: Humana Medicaid |
$105.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.97
|
| Rate for Payer: Molina Healthcare Passport |
$105.85
|
| Rate for Payer: Multiplan PHCS |
$634.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.07
|
| Rate for Payer: UHCCP Medicaid |
$369.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.67
|
|
|
INTRACRANIAL STUDY
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,587.84 |
| Rate for Payer: Aetna Commercial |
$1,273.58
|
| Rate for Payer: Anthem Medicaid |
$568.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$1,372.82
|
| Rate for Payer: First Health Commercial |
$1,571.30
|
| Rate for Payer: Humana Commercial |
$1,405.90
|
| Rate for Payer: Humana KY Medicaid |
$568.81
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$574.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,356.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,220.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$580.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,455.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,240.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.26
|
| Rate for Payer: PHCS Commercial |
$1,587.84
|
| Rate for Payer: United Healthcare All Payer |
$1,455.52
|
|
|
INTRACRANIAL STUDY
|
Professional
|
Both
|
$1,654.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$992.40 |
| Rate for Payer: Aetna Commercial |
$306.83
|
| Rate for Payer: Ambetter Exchange |
$229.18
|
| Rate for Payer: Anthem Medicaid |
$158.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.02
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$390.43
|
| Rate for Payer: Healthspan PPO |
$327.76
|
| Rate for Payer: Humana Medicaid |
$158.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.00
|
| Rate for Payer: Molina Healthcare Passport |
$158.82
|
| Rate for Payer: Multiplan PHCS |
$992.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.93
|
| Rate for Payer: UHCCP Medicaid |
$578.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.18
|
|
|
INTRACRANIAL STUDY
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
32000296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$496.20 |
| Max. Negotiated Rate |
$1,587.84 |
| Rate for Payer: Aetna Commercial |
$1,273.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.12
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$1,372.82
|
| Rate for Payer: First Health Commercial |
$1,571.30
|
| Rate for Payer: Humana Commercial |
$1,405.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,356.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,220.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,455.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,240.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.26
|
| Rate for Payer: PHCS Commercial |
$1,587.84
|
| Rate for Payer: United Healthcare All Payer |
$1,455.52
|
|
|
INTRACRANIAL STUDY(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
320P0297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.62 |
| Max. Negotiated Rate |
$253.58 |
| Rate for Payer: Aetna Commercial |
$145.48
|
| Rate for Payer: Ambetter Exchange |
$144.67
|
| Rate for Payer: Anthem Medicaid |
$105.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$173.60
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$253.58
|
| Rate for Payer: Healthspan PPO |
$155.40
|
| Rate for Payer: Humana Medicaid |
$105.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$41.62
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.97
|
| Rate for Payer: Molina Healthcare Passport |
$105.85
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$188.07
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.67
|
|
|
INTRACRANIAL STUDY(P
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
320P0296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$390.43 |
| Rate for Payer: Aetna Commercial |
$306.83
|
| Rate for Payer: Ambetter Exchange |
$229.18
|
| Rate for Payer: Anthem Medicaid |
$158.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$229.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$229.18
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.02
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cash Price |
$187.50
|
| Rate for Payer: Cigna Commercial |
$390.43
|
| Rate for Payer: Healthspan PPO |
$327.76
|
| Rate for Payer: Humana Medicaid |
$158.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.20
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$229.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$229.18
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$162.00
|
| Rate for Payer: Molina Healthcare Passport |
$158.82
|
| Rate for Payer: Multiplan PHCS |
$225.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.93
|
| Rate for Payer: UHCCP Medicaid |
$131.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$160.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$229.18
|
|
|
INTRACRANIAL STUDY(T
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
HCPCS 93888
|
| Hospital Charge Code |
320T0297
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.10 |
| Max. Negotiated Rate |
$726.72 |
| Rate for Payer: Aetna Commercial |
$582.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.46
|
| Rate for Payer: Cash Price |
$378.50
|
| Rate for Payer: Cigna Commercial |
$628.31
|
| Rate for Payer: First Health Commercial |
$719.15
|
| Rate for Payer: Humana Commercial |
$643.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$620.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$558.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.16
|
| Rate for Payer: Ohio Health Group HMO |
$567.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$605.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$522.33
|
| Rate for Payer: PHCS Commercial |
$726.72
|
| Rate for Payer: United Healthcare All Payer |
$666.16
|
|
|
INTRACRANIAL STUDY(T
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
320T0296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,227.84 |
| Rate for Payer: Aetna Commercial |
$984.83
|
| Rate for Payer: Anthem Medicaid |
$439.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$997.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cigna Commercial |
$1,061.57
|
| Rate for Payer: First Health Commercial |
$1,215.05
|
| Rate for Payer: Humana Commercial |
$1,087.15
|
| Rate for Payer: Humana KY Medicaid |
$439.85
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$444.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,048.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$448.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,125.52
|
| Rate for Payer: Ohio Health Group HMO |
$959.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$882.51
|
| Rate for Payer: PHCS Commercial |
$1,227.84
|
| Rate for Payer: United Healthcare All Payer |
$1,125.52
|
|
|
INTRACRANIAL STUDY(T
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
HCPCS 93886
|
| Hospital Charge Code |
320T0296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.70 |
| Max. Negotiated Rate |
$1,227.84 |
| Rate for Payer: Aetna Commercial |
$984.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$997.62
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cigna Commercial |
$1,061.57
|
| Rate for Payer: First Health Commercial |
$1,215.05
|
| Rate for Payer: Humana Commercial |
$1,087.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,048.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,125.52
|
| Rate for Payer: Ohio Health Group HMO |
$959.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$882.51
|
| Rate for Payer: PHCS Commercial |
$1,227.84
|
| Rate for Payer: United Healthcare All Payer |
$1,125.52
|
|
