|
OS ZONISAMIDE S
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 80203
|
| Hospital Charge Code |
30000053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$13.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$184.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.25
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$13.25
|
| Rate for Payer: Humana Medicare Advantage |
$13.25
|
| Rate for Payer: Kentucky WC Medicaid |
$13.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
OT ADL/SELF CARE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
OT ADL/SELF CARE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
43000024
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
OT COMM/WORK REINTEGRATION
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
43000025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.10
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Humana KY Medicaid |
$32.67
|
| Rate for Payer: Kentucky WC Medicaid |
$33.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OT COMM/WORK REINTEGRATION
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
43000025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$74.10
|
| Rate for Payer: Cash Price |
$47.50
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: First Health Commercial |
$90.25
|
| Rate for Payer: Humana Commercial |
$80.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.60
|
| Rate for Payer: Ohio Health Group HMO |
$71.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$76.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.55
|
| Rate for Payer: PHCS Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Payer |
$83.60
|
|
|
OT EVAL HIGH
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
HCPCS 97167
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem Medicaid |
$114.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Humana KY Medicaid |
$114.52
|
| Rate for Payer: Kentucky WC Medicaid |
$115.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
OT EVAL HIGH
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
HCPCS 97167
|
| Hospital Charge Code |
43000021
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$99.90 |
| Max. Negotiated Rate |
$319.68 |
| Rate for Payer: Aetna Commercial |
$256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$259.74
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$276.39
|
| Rate for Payer: First Health Commercial |
$316.35
|
| Rate for Payer: Humana Commercial |
$283.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$245.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.04
|
| Rate for Payer: Ohio Health Group HMO |
$249.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$289.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$229.77
|
| Rate for Payer: PHCS Commercial |
$319.68
|
| Rate for Payer: United Healthcare All Payer |
$293.04
|
|
|
OT EVAL LOW
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS 97165
|
| Hospital Charge Code |
43000019
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
OT EVAL LOW
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS 97165
|
| Hospital Charge Code |
43000019
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$242.55
|
| Rate for Payer: Anthem Medicaid |
$108.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$245.70
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$261.45
|
| Rate for Payer: First Health Commercial |
$299.25
|
| Rate for Payer: Humana Commercial |
$267.75
|
| Rate for Payer: Humana KY Medicaid |
$108.33
|
| Rate for Payer: Kentucky WC Medicaid |
$109.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$258.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$232.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$110.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$277.20
|
| Rate for Payer: Ohio Health Group HMO |
$236.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$217.35
|
| Rate for Payer: PHCS Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Payer |
$277.20
|
|
|
OT EVAL MOD
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
HCPCS 97166
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem Medicaid |
$110.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Humana KY Medicaid |
$110.74
|
| Rate for Payer: Kentucky WC Medicaid |
$111.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.18
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
OT EVAL MOD
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
HCPCS 97166
|
| Hospital Charge Code |
43000020
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$247.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$251.16
|
| Rate for Payer: Cash Price |
$161.00
|
| Rate for Payer: Cigna Commercial |
$267.26
|
| Rate for Payer: First Health Commercial |
$305.90
|
| Rate for Payer: Humana Commercial |
$273.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$264.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.36
|
| Rate for Payer: Ohio Health Group HMO |
$241.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$222.18
|
| Rate for Payer: PHCS Commercial |
$309.12
|
| Rate for Payer: United Healthcare All Payer |
$283.36
|
|
|
OTOLARYNGOLOGIC EXAM
|
Facility
|
OP
|
$3,283.57
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
76102449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$3,152.23 |
| Rate for Payer: Aetna Commercial |
$2,528.35
|
| Rate for Payer: Anthem Medicaid |
$1,129.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,641.79
|
| Rate for Payer: Cash Price |
$1,641.79
|
| Rate for Payer: Cigna Commercial |
$2,725.36
|
| Rate for Payer: First Health Commercial |
$3,119.39
|
| Rate for Payer: Humana Commercial |
$2,791.03
|
| Rate for Payer: Humana KY Medicaid |
$1,129.22
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,626.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.66
|
| Rate for Payer: PHCS Commercial |
$3,152.23
|
| Rate for Payer: United Healthcare All Payer |
$2,889.54
|
|
|
OTOLARYNGOLOGIC EXAM
|
Facility
|
IP
|
$3,283.57
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
76102449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$985.07 |
| Max. Negotiated Rate |
$3,152.23 |
| Rate for Payer: Aetna Commercial |
$2,528.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.18
|
| Rate for Payer: Cash Price |
$1,641.79
|
| Rate for Payer: Cigna Commercial |
$2,725.36
|
| Rate for Payer: First Health Commercial |
$3,119.39
|
| Rate for Payer: Humana Commercial |
$2,791.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,626.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,856.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,265.66
|
| Rate for Payer: PHCS Commercial |
$3,152.23
|
| Rate for Payer: United Healthcare All Payer |
$2,889.54
|
|
|
OTOLARYNGOLOGIC EXAM
|
Professional
|
Both
|
$3,283.57
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
76102449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.27 |
| Max. Negotiated Rate |
$1,970.14 |
| Rate for Payer: Aetna Commercial |
$121.26
|
| Rate for Payer: Ambetter Exchange |
$89.02
|
| Rate for Payer: Anthem Medicaid |
$77.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.82
|
| Rate for Payer: Cash Price |
$1,641.79
|
| Rate for Payer: Cash Price |
$1,641.79
|
| Rate for Payer: Cigna Commercial |
$143.58
|
| Rate for Payer: Healthspan PPO |
$116.73
|
| Rate for Payer: Humana Medicaid |
$77.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.82
|
| Rate for Payer: Molina Healthcare Passport |
$77.27
|
| Rate for Payer: Multiplan PHCS |
$1,970.14
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.73
|
| Rate for Payer: UHCCP Medicaid |
$1,149.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.02
|
|
|
OTOLARYNGOLOGIC EXAM(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
761P2449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$77.27 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$121.26
|
| Rate for Payer: Ambetter Exchange |
$89.02
|
| Rate for Payer: Anthem Medicaid |
$77.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$89.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$89.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.82
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$143.58
|
| Rate for Payer: Healthspan PPO |
$116.73
|
| Rate for Payer: Humana Medicaid |
$77.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$89.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.82
|
| Rate for Payer: Molina Healthcare Passport |
$77.27
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.73
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$89.02
|
|
|
OTOLARYNGOLOGIC EXAM(T
|
Facility
|
IP
|
$2,983.57
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
761T2449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.07 |
| Max. Negotiated Rate |
$2,864.23 |
| Rate for Payer: Aetna Commercial |
$2,297.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,327.18
|
| Rate for Payer: Cash Price |
$1,491.79
|
| Rate for Payer: Cigna Commercial |
$2,476.36
|
| Rate for Payer: First Health Commercial |
$2,834.39
|
| Rate for Payer: Humana Commercial |
$2,536.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,446.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,201.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$895.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,625.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,237.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,386.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,058.66
|
| Rate for Payer: PHCS Commercial |
$2,864.23
|
| Rate for Payer: United Healthcare All Payer |
$2,625.54
|
|
|
OTOLARYNGOLOGIC EXAM(T
|
Facility
|
OP
|
$2,983.57
|
|
|
Service Code
|
HCPCS 92502
|
| Hospital Charge Code |
761T2449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$470.54 |
| Max. Negotiated Rate |
$2,864.23 |
| Rate for Payer: Aetna Commercial |
$2,297.35
|
| Rate for Payer: Anthem Medicaid |
$1,026.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,327.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$658.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$635.23
|
| Rate for Payer: Cash Price |
$1,491.79
|
| Rate for Payer: Cash Price |
$1,491.79
|
| Rate for Payer: Cigna Commercial |
$2,476.36
|
| Rate for Payer: First Health Commercial |
$2,834.39
|
| Rate for Payer: Humana Commercial |
$2,536.03
|
| Rate for Payer: Humana KY Medicaid |
$1,026.05
|
| Rate for Payer: Humana Medicare Advantage |
$470.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,036.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,446.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,201.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,046.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,625.54
|
| Rate for Payer: Ohio Health Group HMO |
$2,237.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,386.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,058.66
|
| Rate for Payer: PHCS Commercial |
$2,864.23
|
| Rate for Payer: United Healthcare All Payer |
$2,625.54
|
|
|
OTOPLASTY BILATERAL
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
22200043
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| 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: Humana KY Medicaid |
$275.12
|
| 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 |
$240.00
|
| 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
|
|
|
OTOPLASTY BILATERAL
|
Facility
|
IP
|
$800.00
|
|
| Hospital Charge Code |
22200043
|
|
Hospital Revenue Code
|
222
|
| 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
|
|
|
OTOPLASTY BILATERAL
|
Professional
|
Both
|
$800.00
|
|
| Hospital Charge Code |
22200043
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$560.00
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
|
|
OTOPLASTY BILATERAL -80
|
Facility
|
OP
|
$400.00
|
|
| Hospital Charge Code |
22200376
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem Medicaid |
$137.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Humana KY Medicaid |
$137.56
|
| Rate for Payer: Kentucky WC Medicaid |
$138.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
OTOPLASTY BILATERAL -80
|
Facility
|
IP
|
$400.00
|
|
| Hospital Charge Code |
22200376
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$308.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$332.00
|
| Rate for Payer: First Health Commercial |
$380.00
|
| Rate for Payer: Humana Commercial |
$340.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.00
|
| Rate for Payer: Ohio Health Group HMO |
$300.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.00
|
| Rate for Payer: PHCS Commercial |
$384.00
|
| Rate for Payer: United Healthcare All Payer |
$352.00
|
|
|
OTOPLASTY BILATERAL -80
|
Professional
|
Both
|
$400.00
|
|
| Hospital Charge Code |
22200376
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
|
|
OT RE EVAL CARE PLAN
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 97168
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.32
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.36
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
|
OT RE EVAL CARE PLAN
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 97168
|
| Hospital Charge Code |
43000022
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$138.24 |
| Rate for Payer: Aetna Commercial |
$110.88
|
| Rate for Payer: Anthem Medicaid |
$49.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$112.32
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$119.52
|
| Rate for Payer: First Health Commercial |
$136.80
|
| Rate for Payer: Humana Commercial |
$122.40
|
| Rate for Payer: Humana KY Medicaid |
$49.52
|
| Rate for Payer: Kentucky WC Medicaid |
$50.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$118.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$106.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$50.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$126.72
|
| Rate for Payer: Ohio Health Group HMO |
$108.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$115.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.36
|
| Rate for Payer: PHCS Commercial |
$138.24
|
| Rate for Payer: United Healthcare All Payer |
$126.72
|
|
