|
PSA SCREEN
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30000487
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$63.60 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: Ambetter Exchange |
$18.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.07
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cash Price |
$53.00
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Healthspan PPO |
$33.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.39
|
| Rate for Payer: Multiplan PHCS |
$63.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.91
|
| Rate for Payer: UHCCP Medicaid |
$37.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
|
|
PSA SCREEN G0103
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 84153
|
| Hospital Charge Code |
30001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$60.60 |
| Rate for Payer: Aetna Commercial |
$33.92
|
| Rate for Payer: Ambetter Exchange |
$18.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$18.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$18.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$22.07
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$16.29
|
| Rate for Payer: Healthspan PPO |
$33.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.39
|
| Rate for Payer: Multiplan PHCS |
$60.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$23.91
|
| Rate for Payer: UHCCP Medicaid |
$35.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$18.39
|
|
|
PSA SCREEN G0103
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
PSA SCREEN G0103
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS G0103
|
| Hospital Charge Code |
30001867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Aetna Commercial |
$77.77
|
| Rate for Payer: Anthem Medicaid |
$19.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$19.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$81.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$27.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.31
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cash Price |
$50.50
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: First Health Commercial |
$95.95
|
| Rate for Payer: Humana Commercial |
$85.85
|
| 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 |
$82.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$74.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$19.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.88
|
| Rate for Payer: Ohio Health Group HMO |
$75.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.69
|
| Rate for Payer: PHCS Commercial |
$96.96
|
| Rate for Payer: United Healthcare All Payer |
$88.88
|
|
|
PSEUDOMONA AERUGINOSA SODA GEN
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001303
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem Medicaid |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$20.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$28.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$20.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| 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 |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
PSEUDOMONA AERUGINOSA SODA GEN
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
HCPCS 87149
|
| Hospital Charge Code |
30001303
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$69.12 |
| Rate for Payer: Aetna Commercial |
$55.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$57.82
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$59.76
|
| Rate for Payer: First Health Commercial |
$68.40
|
| Rate for Payer: Humana Commercial |
$61.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$63.36
|
| Rate for Payer: Ohio Health Group HMO |
$54.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.68
|
| Rate for Payer: PHCS Commercial |
$69.12
|
| Rate for Payer: United Healthcare All Payer |
$63.36
|
|
|
PSN STRAIGHT HYBST 14*30
|
Facility
|
OP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem Medicaid |
$3,854.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Humana KY Medicaid |
$3,854.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,893.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,931.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
PSN STRAIGHT HYBST 14*30
|
Facility
|
IP
|
$11,207.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,362.10 |
| Max. Negotiated Rate |
$10,758.72 |
| Rate for Payer: Aetna Commercial |
$8,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,741.46
|
| Rate for Payer: Cash Price |
$5,603.50
|
| Rate for Payer: Cigna Commercial |
$9,301.81
|
| Rate for Payer: First Health Commercial |
$10,646.65
|
| Rate for Payer: Humana Commercial |
$9,525.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,189.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,270.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,362.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,862.16
|
| Rate for Payer: Ohio Health Group HMO |
$8,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,965.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,750.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,732.83
|
| Rate for Payer: PHCS Commercial |
$10,758.72
|
| Rate for Payer: United Healthcare All Payer |
$9,862.16
|
|
|
PS POSI SYSTEM INFLA ASSEMBLY
|
Facility
|
OP
|
$558.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.41 |
| Max. Negotiated Rate |
$535.73 |
| Rate for Payer: Aetna Commercial |
$429.70
|
| Rate for Payer: Anthem Medicaid |
$191.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.28
|
| Rate for Payer: Cash Price |
$279.02
|
| Rate for Payer: Cigna Commercial |
$463.18
|
| Rate for Payer: First Health Commercial |
$530.15
|
| Rate for Payer: Humana Commercial |
$474.34
|
| Rate for Payer: Humana KY Medicaid |
$191.91
|
| Rate for Payer: Kentucky WC Medicaid |
$193.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.08
|
| Rate for Payer: Ohio Health Group HMO |
$418.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.05
|
| Rate for Payer: PHCS Commercial |
$535.73
|
| Rate for Payer: United Healthcare All Payer |
$491.08
|
|
|
PS POSI SYSTEM INFLA ASSEMBLY
|
Facility
|
IP
|
$558.05
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.41 |
| Max. Negotiated Rate |
$535.73 |
| Rate for Payer: Aetna Commercial |
$429.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.28
|
| Rate for Payer: Cash Price |
$279.02
|
| Rate for Payer: Cigna Commercial |
$463.18
|
| Rate for Payer: First Health Commercial |
$530.15
|
| Rate for Payer: Humana Commercial |
$474.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.08
|
| Rate for Payer: Ohio Health Group HMO |
$418.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.05
|
| Rate for Payer: PHCS Commercial |
$535.73
|
| Rate for Payer: United Healthcare All Payer |
$491.08
|
|
|
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 |
$148.46 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$478.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$490.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.97
|
| Rate for Payer: PHCS Commercial |
$588.48
|
| Rate for Payer: United Healthcare All Payer |
$539.44
|
|
|
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 |
$367.80 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Ambetter Exchange |
$161.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.90
|
| Rate for Payer: Anthem Medicaid |
$105.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$161.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$161.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$194.05
|
| 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 |
$105.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$161.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.41
|
| Rate for Payer: Molina Healthcare Passport |
$105.30
|
| Rate for Payer: Multiplan PHCS |
$367.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.22
|
| Rate for Payer: UHCCP Medicaid |
$92.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$161.71
|
|
|
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 |
$183.90 |
| 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 |
$490.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$422.97
|
| 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 |
$213.04 |
| Rate for Payer: Aetna Commercial |
$213.04
|
| Rate for Payer: Ambetter Exchange |
$161.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$87.90
|
| Rate for Payer: Anthem Medicaid |
$105.30
|
| Rate for Payer: Buckeye Individual/Medicaid |
$161.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$161.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$194.05
|
| 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 |
$105.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$177.47
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$161.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$161.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.41
|
| Rate for Payer: Molina Healthcare Passport |
$105.30
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.22
|
| Rate for Payer: UHCCP Medicaid |
$92.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$161.71
|
|
|
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 |
$93.90 |
| 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 |
$250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.97
|
| 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 |
$107.64 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$244.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.97
|
| Rate for Payer: PHCS Commercial |
$300.48
|
| Rate for Payer: United Healthcare All Payer |
$275.44
|
|
|
PSYCHOTHERAPY 30 MINS W/PT
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90000001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$86.40 |
| 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 |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| 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 |
$172.80 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Ambetter Exchange |
$68.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.58
|
| Rate for Payer: Anthem Medicaid |
$47.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.94
|
| 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 |
$47.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.36
|
| Rate for Payer: Molina Healthcare Passport |
$47.41
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.76
|
| Rate for Payer: UHCCP Medicaid |
$37.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.28
|
|
|
PSYCHOTHERAPY 30 MINS W/PT
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90000001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$99.04 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
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 |
$172.80 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Ambetter Exchange |
$68.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.58
|
| Rate for Payer: Anthem Medicaid |
$47.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.94
|
| 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 |
$47.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.36
|
| Rate for Payer: Molina Healthcare Passport |
$47.41
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.76
|
| Rate for Payer: UHCCP Medicaid |
$37.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.28
|
|
|
PSYCHOTHERAPY 30 MIN W/PT EV
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
90000017
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| 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: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| 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: Molina Healthcare Medicaid |
$105.24
|
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
PSYCHOTHERAPY 30 MIN W/PT EV
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
90000017
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$101.60
|
| Rate for Payer: Ambetter Exchange |
$63.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.85
|
| Rate for Payer: Anthem Medicaid |
$48.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.32
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$61.81
|
| Rate for Payer: Healthspan PPO |
$37.00
|
| Rate for Payer: Humana Medicaid |
$48.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.32
|
| Rate for Payer: Molina Healthcare Passport |
$48.35
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.68
|
| Rate for Payer: UHCCP Medicaid |
$38.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.60
|
|
|
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 |
$90.00 |
| 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 |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
PSYCHOTHERAPY 30 MIN W/PT EV(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 90833
|
| Hospital Charge Code |
900P0017
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$101.60
|
| Rate for Payer: Ambetter Exchange |
$63.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$36.85
|
| Rate for Payer: Anthem Medicaid |
$48.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$63.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$63.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$76.32
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$61.81
|
| Rate for Payer: Healthspan PPO |
$37.00
|
| Rate for Payer: Humana Medicaid |
$48.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$63.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$49.32
|
| Rate for Payer: Molina Healthcare Passport |
$48.35
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$82.68
|
| Rate for Payer: UHCCP Medicaid |
$38.69
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$48.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$63.60
|
|
|
PSYCHOTHERAPY 45 MIN W/PT EV
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
90000018
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$345.17 |
| Rate for Payer: Aetna Commercial |
$276.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.45
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cigna Commercial |
$298.43
|
| Rate for Payer: First Health Commercial |
$341.57
|
| Rate for Payer: Humana Commercial |
$305.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.40
|
| Rate for Payer: Ohio Health Group HMO |
$269.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.09
|
| Rate for Payer: PHCS Commercial |
$345.17
|
| Rate for Payer: United Healthcare All Payer |
$316.40
|
|
