|
PHYCHOTHERAPY DIAG INTERVIEW
|
Professional
|
Both
|
$570.32
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90000005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$570.32 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.14
|
| Rate for Payer: Anthem Medicaid |
$94.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$570.32
|
| Rate for Payer: Cash Price |
$285.16
|
| Rate for Payer: Cash Price |
$285.16
|
| Rate for Payer: Cigna Commercial |
$221.80
|
| Rate for Payer: Healthspan PPO |
$132.37
|
| Rate for Payer: Humana Medicaid |
$94.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.74
|
| Rate for Payer: Molina Healthcare Passport |
$94.84
|
| Rate for Payer: Multiplan PHCS |
$342.19
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$399.22
|
| Rate for Payer: UHCCP Medicaid |
$81.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.79
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW
|
Facility
|
OP
|
$570.32
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90000005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$74.14 |
| Max. Negotiated Rate |
$547.51 |
| Rate for Payer: Aetna Commercial |
$439.15
|
| Rate for Payer: Anthem Medicaid |
$196.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.85
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$285.16
|
| Rate for Payer: Cash Price |
$285.16
|
| Rate for Payer: Cigna Commercial |
$473.37
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: Humana Commercial |
$484.77
|
| Rate for Payer: Humana KY Medicaid |
$196.13
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$198.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.88
|
| Rate for Payer: Ohio Health Group HMO |
$427.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.80
|
| Rate for Payer: PHCS Commercial |
$547.51
|
| Rate for Payer: United Healthcare All Payer |
$501.88
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW
|
Facility
|
IP
|
$570.32
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
90000005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$74.14 |
| Max. Negotiated Rate |
$547.51 |
| Rate for Payer: Aetna Commercial |
$439.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$444.85
|
| Rate for Payer: Cash Price |
$285.16
|
| Rate for Payer: Cigna Commercial |
$473.37
|
| Rate for Payer: First Health Commercial |
$541.80
|
| Rate for Payer: Humana Commercial |
$484.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$467.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$420.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$501.88
|
| Rate for Payer: Ohio Health Group HMO |
$427.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.80
|
| Rate for Payer: PHCS Commercial |
$547.51
|
| Rate for Payer: United Healthcare All Payer |
$501.88
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
900P0005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$77.14 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$77.14
|
| Rate for Payer: Anthem Medicaid |
$94.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$221.80
|
| Rate for Payer: Healthspan PPO |
$132.37
|
| Rate for Payer: Humana Medicaid |
$94.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.74
|
| Rate for Payer: Molina Healthcare Passport |
$94.84
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$81.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.79
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW(T
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
900T0005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.54
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
PHYCHOTHERAPY DIAG INTERVIEW(T
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS 90791
|
| Hospital Charge Code |
900T0005
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$320.64 |
| Rate for Payer: Aetna Commercial |
$257.18
|
| Rate for Payer: Anthem Medicaid |
$114.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$260.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cash Price |
$167.00
|
| Rate for Payer: Cigna Commercial |
$277.22
|
| Rate for Payer: First Health Commercial |
$317.30
|
| Rate for Payer: Humana Commercial |
$283.90
|
| Rate for Payer: Humana KY Medicaid |
$114.86
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$116.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$273.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$246.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$293.92
|
| Rate for Payer: Ohio Health Group HMO |
$250.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$66.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$43.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.54
|
| Rate for Payer: PHCS Commercial |
$320.64
|
| Rate for Payer: United Healthcare All Payer |
$293.92
|
|
|
PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
HCPCS 94626
|
| Hospital Charge Code |
41000116
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.28
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$67.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.06
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
PHY/QHP OP PULM RHB W/MNTR
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
HCPCS 94626
|
| Hospital Charge Code |
41000116
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$216.96 |
| Rate for Payer: Aetna Commercial |
$174.02
|
| Rate for Payer: Anthem Medicaid |
$77.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$176.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cash Price |
$113.00
|
| Rate for Payer: Cigna Commercial |
$187.58
|
| Rate for Payer: First Health Commercial |
$214.70
|
| Rate for Payer: Humana Commercial |
$192.10
|
| Rate for Payer: Humana KY Medicaid |
$77.72
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$78.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$185.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$166.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$198.88
|
| Rate for Payer: Ohio Health Group HMO |
$169.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$45.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$29.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.06
|
| Rate for Payer: PHCS Commercial |
$216.96
|
| Rate for Payer: United Healthcare All Payer |
$198.88
|
|
|
PHYS BLOOD BANK SERV REACTJ
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
30001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$43.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$43.54
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$43.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
PHYS BLOOD BANK SERV REACTJ
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
30001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
PHYS BLOOD BANK SERV REACTJ
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 86078
|
| Hospital Charge Code |
30001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$73.53
|
| Rate for Payer: Anthem Medicaid |
$37.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$31.67
|
| Rate for Payer: Healthspan PPO |
$37.35
|
| Rate for Payer: Humana Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.89
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.63
|
| Rate for Payer: Molina Healthcare Passport |
$37.87
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.70
|
| Rate for Payer: UHCCP Medicaid |
$91.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.12
|
|
|
PHYS BLOOD BANK SERV XMATCH
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS 86077
|
| Hospital Charge Code |
30001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.93 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
PHYS BLOOD BANK SERV XMATCH
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS 86077
|
| Hospital Charge Code |
30001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.75 |
| Max. Negotiated Rate |
$250.56 |
| Rate for Payer: Aetna Commercial |
$200.97
|
| Rate for Payer: Anthem Medicaid |
$39.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.76
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$216.63
|
| Rate for Payer: First Health Commercial |
$247.95
|
| Rate for Payer: Humana Commercial |
$221.85
|
| Rate for Payer: Humana KY Medicaid |
$39.16
|
| Rate for Payer: Humana Medicare Advantage |
$25.75
|
| Rate for Payer: Kentucky WC Medicaid |
$39.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$214.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$39.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.68
|
| Rate for Payer: Ohio Health Group HMO |
$195.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.91
|
| Rate for Payer: PHCS Commercial |
$250.56
|
| Rate for Payer: United Healthcare All Payer |
$229.68
|
|
|
PHYS BLOOD BANK SERV XMATCH
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 86077
|
| Hospital Charge Code |
30001573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna Commercial |
$73.53
|
| Rate for Payer: Anthem Medicaid |
$37.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$261.00
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$31.42
|
| Rate for Payer: Healthspan PPO |
$37.44
|
| Rate for Payer: Humana Medicaid |
$37.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$25.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.36
|
| Rate for Payer: Molina Healthcare Passport |
$37.61
|
| Rate for Payer: Multiplan PHCS |
$156.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.70
|
| Rate for Payer: UHCCP Medicaid |
$91.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.50
|
|
|
PHYS REVIEW/INTERPRETATION
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
41000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem Medicaid |
$73.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.92
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Humana KY Medicaid |
$73.59
|
| Rate for Payer: Kentucky WC Medicaid |
$74.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.34
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
PHYS REVIEW/INTERPRETATION
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
41000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.82 |
| Max. Negotiated Rate |
$205.44 |
| Rate for Payer: Aetna Commercial |
$164.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$166.92
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$177.62
|
| Rate for Payer: First Health Commercial |
$203.30
|
| Rate for Payer: Humana Commercial |
$181.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$175.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$157.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$188.32
|
| Rate for Payer: Ohio Health Group HMO |
$160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$42.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.34
|
| Rate for Payer: PHCS Commercial |
$205.44
|
| Rate for Payer: United Healthcare All Payer |
$188.32
|
|
|
PHYS REVIEW/INTERPRETATION
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
41000102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$214.00 |
| Rate for Payer: Aetna Commercial |
$39.48
|
| Rate for Payer: Anthem Medicaid |
$4.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$214.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cash Price |
$107.00
|
| Rate for Payer: Cigna Commercial |
$37.71
|
| Rate for Payer: Healthspan PPO |
$30.58
|
| Rate for Payer: Humana Medicaid |
$4.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.99
|
| Rate for Payer: Molina Healthcare Passport |
$4.89
|
| Rate for Payer: Multiplan PHCS |
$128.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$149.80
|
| Rate for Payer: UHCCP Medicaid |
$74.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.94
|
|
|
PHYS REVIEW/INTERPRETATION(P
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
410P0102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Aetna Commercial |
$39.48
|
| Rate for Payer: Anthem Medicaid |
$4.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.00
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Cigna Commercial |
$37.71
|
| Rate for Payer: Healthspan PPO |
$30.58
|
| Rate for Payer: Humana Medicaid |
$4.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$4.99
|
| Rate for Payer: Molina Healthcare Passport |
$4.89
|
| Rate for Payer: Multiplan PHCS |
$31.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$37.10
|
| Rate for Payer: UHCCP Medicaid |
$18.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$4.94
|
|
|
PHYS REVIEW/INTERPRETATION(T
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
410T0102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.58
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
PHYS REVIEW/INTERPRETATION(T
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS 94016
|
| Hospital Charge Code |
410T0102
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$123.97
|
| Rate for Payer: Anthem Medicaid |
$55.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$125.58
|
| Rate for Payer: Cash Price |
$80.50
|
| Rate for Payer: Cigna Commercial |
$133.63
|
| Rate for Payer: First Health Commercial |
$152.95
|
| Rate for Payer: Humana Commercial |
$136.85
|
| Rate for Payer: Humana KY Medicaid |
$55.37
|
| Rate for Payer: Kentucky WC Medicaid |
$55.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$132.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$141.68
|
| Rate for Payer: Ohio Health Group HMO |
$120.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.91
|
| Rate for Payer: PHCS Commercial |
$154.56
|
| Rate for Payer: United Healthcare All Payer |
$141.68
|
|
|
PHYS REVIEW OF CVP MONITORING
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 93790
|
| Hospital Charge Code |
48000101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
PHYS REVIEW OF CVP MONITORING
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 93790
|
| Hospital Charge Code |
48000101
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
PICC 4.5 FR SINGLE W/STYLETT
|
Facility
|
IP
|
$3,244.17
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.74 |
| Max. Negotiated Rate |
$3,114.40 |
| Rate for Payer: Aetna Commercial |
$2,498.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,530.45
|
| Rate for Payer: Cash Price |
$1,622.08
|
| Rate for Payer: Cigna Commercial |
$2,692.66
|
| Rate for Payer: First Health Commercial |
$3,081.96
|
| Rate for Payer: Humana Commercial |
$2,757.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,854.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,005.69
|
| Rate for Payer: PHCS Commercial |
$3,114.40
|
| Rate for Payer: United Healthcare All Payer |
$2,854.87
|
|
|
PICC 4.5 FR SINGLE W/STYLETT
|
Facility
|
OP
|
$3,244.17
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.74 |
| Max. Negotiated Rate |
$3,114.40 |
| Rate for Payer: Aetna Commercial |
$2,498.01
|
| Rate for Payer: Anthem Medicaid |
$1,115.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,530.45
|
| Rate for Payer: Cash Price |
$1,622.08
|
| Rate for Payer: Cigna Commercial |
$2,692.66
|
| Rate for Payer: First Health Commercial |
$3,081.96
|
| Rate for Payer: Humana Commercial |
$2,757.54
|
| Rate for Payer: Humana KY Medicaid |
$1,115.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,660.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,394.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,854.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,433.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$421.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,005.69
|
| Rate for Payer: PHCS Commercial |
$3,114.40
|
| Rate for Payer: United Healthcare All Payer |
$2,854.87
|
|
|
PIGTAIL 110CM
|
Facility
|
IP
|
$504.10
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$483.94 |
| Rate for Payer: Aetna Commercial |
$388.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.20
|
| Rate for Payer: Cash Price |
$252.05
|
| Rate for Payer: Cigna Commercial |
$418.40
|
| Rate for Payer: First Health Commercial |
$478.90
|
| Rate for Payer: Humana Commercial |
$428.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$413.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$443.61
|
| Rate for Payer: Ohio Health Group HMO |
$378.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.27
|
| Rate for Payer: PHCS Commercial |
$483.94
|
| Rate for Payer: United Healthcare All Payer |
$443.61
|
|
