|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
IP
|
$340.71
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
51000158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$327.08 |
| Rate for Payer: Aetna Commercial |
$262.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.75
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cigna Commercial |
$282.79
|
| Rate for Payer: First Health Commercial |
$323.67
|
| Rate for Payer: Humana Commercial |
$289.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.82
|
| Rate for Payer: Ohio Health Group HMO |
$255.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.62
|
| Rate for Payer: PHCS Commercial |
$327.08
|
| Rate for Payer: United Healthcare All Payer |
$299.82
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Professional
|
Both
|
$340.71
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
51000158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$340.71 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.77
|
| Rate for Payer: Anthem Medicaid |
$68.47
|
| Rate for Payer: Buckeye Medicare Advantage |
$340.71
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cigna Commercial |
$126.94
|
| Rate for Payer: Humana Medicaid |
$68.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.84
|
| Rate for Payer: Molina Healthcare Passport |
$68.47
|
| Rate for Payer: Multiplan PHCS |
$204.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$238.50
|
| Rate for Payer: UHCCP Medicaid |
$53.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.15
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
OP
|
$340.71
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
51000158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$327.08 |
| Rate for Payer: Aetna Commercial |
$262.35
|
| Rate for Payer: Anthem Medicaid |
$117.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.75
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cigna Commercial |
$282.79
|
| Rate for Payer: First Health Commercial |
$323.67
|
| Rate for Payer: Humana Commercial |
$289.60
|
| Rate for Payer: Humana KY Medicaid |
$117.17
|
| Rate for Payer: Kentucky WC Medicaid |
$118.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.82
|
| Rate for Payer: Ohio Health Group HMO |
$255.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.62
|
| Rate for Payer: PHCS Commercial |
$327.08
|
| Rate for Payer: United Healthcare All Payer |
$299.82
|
|
|
PSYCL TST EVAL PHYS/QHP EA(P
|
Professional
|
Both
|
$84.71
|
|
| Hospital Charge Code |
510P0158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$84.71 |
| Rate for Payer: Buckeye Medicare Advantage |
$84.71
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Multiplan PHCS |
$50.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.30
|
| Rate for Payer: UHCCP Medicaid |
$29.65
|
|
|
PSYCL TST EVAL PHYS/QHP EA(T
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
510T0158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
PSYCL TST EVAL PHYS/QHP EA(T
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
510T0158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$88.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Humana KY Medicaid |
$88.04
|
| Rate for Payer: Kentucky WC Medicaid |
$88.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
PSY EVAL OF RECORDS
|
Facility
|
IP
|
$260.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
90000012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$200.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.19
|
| Rate for Payer: Cash Price |
$130.25
|
| Rate for Payer: Cigna Commercial |
$216.22
|
| Rate for Payer: First Health Commercial |
$247.48
|
| Rate for Payer: Humana Commercial |
$221.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.24
|
| Rate for Payer: Ohio Health Group HMO |
$195.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.76
|
| Rate for Payer: PHCS Commercial |
$250.08
|
| Rate for Payer: United Healthcare All Payer |
$229.24
|
|
|
PSY EVAL OF RECORDS
|
Facility
|
OP
|
$260.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
90000012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$200.58
|
| Rate for Payer: Anthem Medicaid |
$89.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$203.19
|
| Rate for Payer: Cash Price |
$130.25
|
| Rate for Payer: Cigna Commercial |
$216.22
|
| Rate for Payer: First Health Commercial |
$247.48
|
| Rate for Payer: Humana Commercial |
$221.42
|
| Rate for Payer: Humana KY Medicaid |
$89.59
|
| Rate for Payer: Kentucky WC Medicaid |
$90.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$213.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$192.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$229.24
|
| Rate for Payer: Ohio Health Group HMO |
$195.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.76
|
| Rate for Payer: PHCS Commercial |
$250.08
|
| Rate for Payer: United Healthcare All Payer |
$229.24
|
|
|
PSY EVAL OF RECORDS
|
Professional
|
Both
|
$260.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
90000012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$260.50 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$260.50
|
| Rate for Payer: Cash Price |
$130.25
|
| Rate for Payer: Cash Price |
$130.25
|
| Rate for Payer: Cigna Commercial |
$61.48
|
| Rate for Payer: Healthspan PPO |
$56.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.67
|
| Rate for Payer: Multiplan PHCS |
$156.30
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$182.35
|
| Rate for Payer: UHCCP Medicaid |
$91.18
|
|
|
PSY EVAL OF RECORDS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
900P0012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$61.48
|
| Rate for Payer: Healthspan PPO |
$56.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.67
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
PSY EVAL OF RECORDS(T
|
Facility
|
IP
|
$110.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
900T0012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.19
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cigna Commercial |
$91.72
|
| Rate for Payer: First Health Commercial |
$104.98
|
| Rate for Payer: Humana Commercial |
$93.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.24
|
| Rate for Payer: Ohio Health Group HMO |
$82.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.26
|
| Rate for Payer: PHCS Commercial |
$106.08
|
| Rate for Payer: United Healthcare All Payer |
$97.24
|
|
|
PSY EVAL OF RECORDS(T
|
Facility
|
OP
|
$110.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
900T0012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$106.08 |
| Rate for Payer: Aetna Commercial |
$85.08
|
| Rate for Payer: Anthem Medicaid |
$38.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.19
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Cigna Commercial |
$91.72
|
| Rate for Payer: First Health Commercial |
$104.98
|
| Rate for Payer: Humana Commercial |
$93.92
|
| Rate for Payer: Humana KY Medicaid |
$38.00
|
| Rate for Payer: Kentucky WC Medicaid |
$38.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$90.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$81.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$97.24
|
| Rate for Payer: Ohio Health Group HMO |
$82.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$34.26
|
| Rate for Payer: PHCS Commercial |
$106.08
|
| Rate for Payer: United Healthcare All Payer |
$97.24
|
|
|
PSYTX W PT 45 MINUTES
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
90000007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
PSYTX W PT 45 MINUTES
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
90000007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$417.00 |
| Rate for Payer: Aetna Commercial |
$138.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.43
|
| Rate for Payer: Anthem Medicaid |
$62.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$417.00
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: Healthspan PPO |
$112.63
|
| Rate for Payer: Humana Medicaid |
$62.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.91
|
| Rate for Payer: Molina Healthcare Passport |
$62.66
|
| Rate for Payer: Multiplan PHCS |
$250.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$291.90
|
| Rate for Payer: UHCCP Medicaid |
$51.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.29
|
|
|
PSYTX W PT 45 MINUTES
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
90000007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
PSYTX W PT 45 MINUTES(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
900P0007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$138.25
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.43
|
| Rate for Payer: Anthem Medicaid |
$62.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$120.00
|
| Rate for Payer: Healthspan PPO |
$112.63
|
| Rate for Payer: Humana Medicaid |
$62.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.91
|
| Rate for Payer: Molina Healthcare Passport |
$62.66
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$51.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.29
|
|
|
PSYTX W PT 45 MINUTES(T
|
Facility
|
OP
|
$267.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
900T0007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem Medicaid |
$91.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Humana KY Medicaid |
$91.82
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$92.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.77
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
PSYTX W PT 45 MINUTES(T
|
Facility
|
IP
|
$267.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
900T0007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: Aetna Commercial |
$205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$221.61
|
| Rate for Payer: First Health Commercial |
$253.65
|
| Rate for Payer: Humana Commercial |
$226.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$218.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$234.96
|
| Rate for Payer: Ohio Health Group HMO |
$200.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.77
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
PT2 GUIDE WIRE 180CM
|
Facility
|
OP
|
$1,142.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$1,096.70 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Anthem Medicaid |
$392.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$891.07
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: First Health Commercial |
$1,085.28
|
| Rate for Payer: Humana Commercial |
$971.04
|
| Rate for Payer: Humana KY Medicaid |
$392.87
|
| Rate for Payer: Kentucky WC Medicaid |
$396.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$400.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,005.31
|
| Rate for Payer: Ohio Health Group HMO |
$856.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.14
|
| Rate for Payer: PHCS Commercial |
$1,096.70
|
| Rate for Payer: United Healthcare All Payer |
$1,005.31
|
|
|
PT2 GUIDE WIRE 180CM
|
Facility
|
IP
|
$1,142.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$1,096.70 |
| Rate for Payer: Aetna Commercial |
$879.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$891.07
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: First Health Commercial |
$1,085.28
|
| Rate for Payer: Humana Commercial |
$971.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$936.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$843.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$342.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,005.31
|
| Rate for Payer: Ohio Health Group HMO |
$856.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.14
|
| Rate for Payer: PHCS Commercial |
$1,096.70
|
| Rate for Payer: United Healthcare All Payer |
$1,005.31
|
|
|
PTA VENOUS
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS
|
Professional
|
Both
|
$6,307.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
76101571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.57 |
| Max. Negotiated Rate |
$6,307.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.57
|
| Rate for Payer: Anthem Medicaid |
$122.68
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,307.00
|
| Rate for Payer: Cash Price |
$3,153.50
|
| Rate for Payer: Cash Price |
$3,153.50
|
| Rate for Payer: Cigna Commercial |
$275.28
|
| Rate for Payer: Humana Medicaid |
$122.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$125.13
|
| Rate for Payer: Molina Healthcare Passport |
$122.68
|
| Rate for Payer: Multiplan PHCS |
$3,784.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,414.90
|
| Rate for Payer: UHCCP Medicaid |
$128.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$123.91
|
|
|
PTA VENOUS
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS
|
Facility
|
IP
|
$6,307.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
76101571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$819.91 |
| Max. Negotiated Rate |
$6,054.72 |
| Rate for Payer: Aetna Commercial |
$4,856.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,919.46
|
| Rate for Payer: Cash Price |
$3,153.50
|
| Rate for Payer: Cigna Commercial |
$5,234.81
|
| Rate for Payer: First Health Commercial |
$5,991.65
|
| Rate for Payer: Humana Commercial |
$5,360.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,171.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,654.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,892.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,550.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,730.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,261.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$819.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,955.17
|
| Rate for Payer: PHCS Commercial |
$6,054.72
|
| Rate for Payer: United Healthcare All Payer |
$5,550.16
|
|
|
PTA VENOUS
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,191.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$774.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,846.67
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
