|
PSA DIAGNOSTIC
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000488
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$94.08 |
| Rate for Payer: Aetna Commercial |
$75.46
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.69
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$81.34
|
| Rate for Payer: First Health Commercial |
$93.10
|
| Rate for Payer: Humana Commercial |
$83.30
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.24
|
| Rate for Payer: Ohio Health Group HMO |
$73.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.38
|
| Rate for Payer: PHCS Commercial |
$94.08
|
| Rate for Payer: United Healthcare All Payer |
$86.24
|
|
|
PSA SCREEN
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
PSA SCREEN
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$18.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$18.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$80.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.75
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.39
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$18.39
|
| Rate for Payer: Humana Medicare Advantage |
$18.39
|
| Rate for Payer: Kentucky WC Medicaid |
$18.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$22.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
PSA SCREEN
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Healthspan PPO |
$33.00
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
|
|
PSA SCREEN G0103
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$96.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Healthspan PPO |
$33.00
|
| Rate for Payer: Multiplan PHCS |
$57.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$67.20
|
| Rate for Payer: UHCCP Medicaid |
$33.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
|
|
PSA SCREEN G0103
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
PSA SCREEN G0103
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$92.16 |
| Rate for Payer: Aetna Commercial |
$73.92
|
| Rate for Payer: Anthem Medicaid |
$19.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.09
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.31
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$79.68
|
| Rate for Payer: First Health Commercial |
$91.20
|
| Rate for Payer: Humana Commercial |
$81.60
|
| Rate for Payer: Humana KY Medicaid |
$19.31
|
| Rate for Payer: Humana Medicare Advantage |
$19.31
|
| Rate for Payer: Kentucky WC Medicaid |
$19.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$78.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$70.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.48
|
| Rate for Payer: Ohio Health Group HMO |
$72.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.76
|
| Rate for Payer: PHCS Commercial |
$92.16
|
| Rate for Payer: United Healthcare All Payer |
$84.48
|
|
|
PSEUDOMONA AERUGINOSA SODA GEN
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001303
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
PSEUDOMONA AERUGINOSA SODA GEN
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001303
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$65.28 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cigna Commercial |
$56.44
|
| Rate for Payer: First Health Commercial |
$64.60
|
| Rate for Payer: Humana Commercial |
$57.80
|
| Rate for Payer: Humana KY Medicaid |
$20.05
|
| Rate for Payer: Humana Medicare Advantage |
$20.05
|
| Rate for Payer: Kentucky WC Medicaid |
$20.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.84
|
| Rate for Payer: Ohio Health Group HMO |
$51.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.08
|
| Rate for Payer: PHCS Commercial |
$65.28
|
| Rate for Payer: United Healthcare All Payer |
$59.84
|
|
|
PSN STRAIGHT HYBST 14*30
|
Facility
|
OP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem Medicaid |
$3,770.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Humana KY Medicaid |
$3,770.86
|
| Rate for Payer: Kentucky WC Medicaid |
$3,809.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,846.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
PSN STRAIGHT HYBST 14*30
|
Facility
|
IP
|
$10,965.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,425.45 |
| Max. Negotiated Rate |
$10,526.40 |
| Rate for Payer: Aetna Commercial |
$8,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,552.70
|
| Rate for Payer: Cash Price |
$5,482.50
|
| Rate for Payer: Cigna Commercial |
$9,100.95
|
| Rate for Payer: First Health Commercial |
$10,416.75
|
| Rate for Payer: Humana Commercial |
$9,320.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,991.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,092.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,649.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,223.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,193.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,425.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,399.15
|
| Rate for Payer: PHCS Commercial |
$10,526.40
|
| Rate for Payer: United Healthcare All Payer |
$9,649.20
|
|
|
PS POSI SYSTEM INFLA ASSEMBLY
|
Facility
|
OP
|
$550.90
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.62 |
| Max. Negotiated Rate |
$528.86 |
| Rate for Payer: Aetna Commercial |
$424.19
|
| Rate for Payer: Anthem Medicaid |
$189.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.70
|
| Rate for Payer: Cash Price |
$275.45
|
| Rate for Payer: Cigna Commercial |
$457.25
|
| Rate for Payer: First Health Commercial |
$523.36
|
| Rate for Payer: Humana Commercial |
$468.26
|
| Rate for Payer: Humana KY Medicaid |
$189.45
|
| Rate for Payer: Kentucky WC Medicaid |
$191.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$193.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.79
|
| Rate for Payer: Ohio Health Group HMO |
$413.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.78
|
| Rate for Payer: PHCS Commercial |
$528.86
|
| Rate for Payer: United Healthcare All Payer |
$484.79
|
|
|
PS POSI SYSTEM INFLA ASSEMBLY
|
Facility
|
IP
|
$550.90
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.62 |
| Max. Negotiated Rate |
$528.86 |
| Rate for Payer: Aetna Commercial |
$424.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.70
|
| Rate for Payer: Cash Price |
$275.45
|
| Rate for Payer: Cigna Commercial |
$457.25
|
| Rate for Payer: First Health Commercial |
$523.36
|
| Rate for Payer: Humana Commercial |
$468.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$406.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.79
|
| Rate for Payer: Ohio Health Group HMO |
$413.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.78
|
| Rate for Payer: PHCS Commercial |
$528.86
|
| Rate for Payer: United Healthcare All Payer |
$484.79
|
|
|
PSYCH DIAG EVAL W/MED SRVCS
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
90000006
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$613.00 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.90
|
| Rate for Payer: Anthem Medicaid |
$102.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$613.00
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$184.98
|
| Rate for Payer: Healthspan PPO |
$110.67
|
| Rate for Payer: Humana Medicaid |
$102.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.54
|
| Rate for Payer: Molina Healthcare Passport |
$102.49
|
| Rate for Payer: Multiplan PHCS |
$367.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$429.10
|
| Rate for Payer: UHCCP Medicaid |
$92.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.51
|
|
|
PSYCH DIAG EVAL W/MED SRVCS
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
90000006
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$79.69 |
| Max. Negotiated Rate |
$588.48 |
| Rate for Payer: Aetna Commercial |
$472.01
|
| Rate for Payer: Anthem Medicaid |
$210.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$508.79
|
| Rate for Payer: First Health Commercial |
$582.35
|
| Rate for Payer: Humana Commercial |
$521.05
|
| Rate for Payer: Humana KY Medicaid |
$210.81
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$212.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$502.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$452.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$215.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$539.44
|
| Rate for Payer: Ohio Health Group HMO |
$459.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.03
|
| Rate for Payer: PHCS Commercial |
$588.48
|
| Rate for Payer: United Healthcare All Payer |
$539.44
|
|
|
PSYCH DIAG EVAL W/MED SRVCS
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
90000006
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$79.69 |
| Max. Negotiated Rate |
$588.48 |
| Rate for Payer: Aetna Commercial |
$472.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.14
|
| Rate for Payer: Cash Price |
$306.50
|
| Rate for Payer: Cigna Commercial |
$508.79
|
| Rate for Payer: First Health Commercial |
$582.35
|
| Rate for Payer: Humana Commercial |
$521.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$502.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$452.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$183.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$539.44
|
| Rate for Payer: Ohio Health Group HMO |
$459.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.03
|
| Rate for Payer: PHCS Commercial |
$588.48
|
| Rate for Payer: United Healthcare All Payer |
$539.44
|
|
|
PSYCH DIAG EVAL W/MED SRVCS(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
900P0006
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.90
|
| Rate for Payer: Anthem Medicaid |
$102.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$184.98
|
| Rate for Payer: Healthspan PPO |
$110.67
|
| Rate for Payer: Humana Medicaid |
$102.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$104.54
|
| Rate for Payer: Molina Healthcare Passport |
$102.49
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$92.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$103.51
|
|
|
PSYCH DIAG EVAL W/MED SRVCS(T
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
900T0006
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.03
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
PSYCH DIAG EVAL W/MED SRVCS(T
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
HCPCS 90792
|
| Hospital Charge Code |
900T0006
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$300.48 |
| Rate for Payer: Aetna Commercial |
$241.01
|
| Rate for Payer: Anthem Medicaid |
$107.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cash Price |
$156.50
|
| Rate for Payer: Cigna Commercial |
$259.79
|
| Rate for Payer: First Health Commercial |
$297.35
|
| Rate for Payer: Humana Commercial |
$266.05
|
| Rate for Payer: Humana KY Medicaid |
$107.64
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$108.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$256.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$275.44
|
| Rate for Payer: Ohio Health Group HMO |
$234.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$97.03
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$15,984.43
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$10,846.58 |
| Max. Negotiated Rate |
$15,984.43 |
| Rate for Payer: Anthem Medicaid |
$10,846.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,417.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$15,984.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,413.56
|
| Rate for Payer: Humana KY Medicaid |
$10,846.58
|
| Rate for Payer: Humana Medicare Advantage |
$11,417.45
|
| Rate for Payer: Kentucky WC Medicaid |
$10,955.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13,700.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,063.51
|
|
|
PSYCHOTHERAPY 30 MINS W/PT
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90000001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
PSYCHOTHERAPY 30 MINS W/PT
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90000001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
PSYCHOTHERAPY 30 MINS W/PT
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90000001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.58
|
| Rate for Payer: Anthem Medicaid |
$46.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$92.42
|
| Rate for Payer: Healthspan PPO |
$80.30
|
| Rate for Payer: Humana Medicaid |
$46.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.88
|
| Rate for Payer: Molina Healthcare Passport |
$46.94
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.60
|
| Rate for Payer: UHCCP Medicaid |
$37.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.41
|
|
|
PSYCHOTHERAPY 30 MINS W/PT(P
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
900P0001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.58
|
| Rate for Payer: Anthem Medicaid |
$46.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$92.42
|
| Rate for Payer: Healthspan PPO |
$80.30
|
| Rate for Payer: Humana Medicaid |
$46.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.88
|
| Rate for Payer: Molina Healthcare Passport |
$46.94
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.60
|
| Rate for Payer: UHCCP Medicaid |
$37.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.41
|
|
|
PSYCHOTHERAPY 30 MIN W/PT EV
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
90000017
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
