|
PSYCL TST EVAL PHYS/QHP EA(T
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
510T0158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.80 |
| 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 |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| 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 |
$76.80 |
| 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 |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
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 |
$182.35 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| 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 |
$91.17
|
|
|
PSY EVAL OF RECORDS
|
Facility
|
OP
|
$260.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
90000012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$200.59
|
| 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 |
$247.47
|
| Rate for Payer: Humana Commercial |
$221.43
|
| 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 |
$208.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.75
|
| Rate for Payer: PHCS Commercial |
$250.08
|
| Rate for Payer: United Healthcare All Payer |
$229.24
|
|
|
PSY EVAL OF RECORDS
|
Facility
|
IP
|
$260.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
90000012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$78.15 |
| Max. Negotiated Rate |
$250.08 |
| Rate for Payer: Aetna Commercial |
$200.59
|
| 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 |
$247.47
|
| Rate for Payer: Humana Commercial |
$221.43
|
| 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 |
$208.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$179.75
|
| Rate for Payer: PHCS Commercial |
$250.08
|
| Rate for Payer: United Healthcare All Payer |
$229.24
|
|
|
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 |
$105.00 |
| Rate for Payer: Aetna Commercial |
$75.62
|
| 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
|
OP
|
$110.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
900T0012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.15 |
| 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 |
$104.97
|
| 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 |
$88.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.25
|
| Rate for Payer: PHCS Commercial |
$106.08
|
| Rate for Payer: United Healthcare All Payer |
$97.24
|
|
|
PSY EVAL OF RECORDS(T
|
Facility
|
IP
|
$110.50
|
|
|
Service Code
|
HCPCS 90885
|
| Hospital Charge Code |
900T0012
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.15 |
| 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 |
$104.97
|
| 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 |
$88.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.25
|
| Rate for Payer: PHCS Commercial |
$106.08
|
| Rate for Payer: United Healthcare All Payer |
$97.24
|
|
|
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 |
$250.20 |
| Rate for Payer: Aetna Commercial |
$138.25
|
| Rate for Payer: Ambetter Exchange |
$90.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.43
|
| Rate for Payer: Anthem Medicaid |
$62.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.06
|
| 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 |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.16
|
| Rate for Payer: Molina Healthcare Passport |
$62.90
|
| Rate for Payer: Multiplan PHCS |
$250.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.06
|
| Rate for Payer: UHCCP Medicaid |
$51.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.05
|
|
|
PSYTX W PT 45 MINUTES
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
90000007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$143.41 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
PSYTX W PT 45 MINUTES
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 90834
|
| Hospital Charge Code |
90000007
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$125.10 |
| 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 |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| 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 |
$138.25 |
| Rate for Payer: Aetna Commercial |
$138.25
|
| Rate for Payer: Ambetter Exchange |
$90.05
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.43
|
| Rate for Payer: Anthem Medicaid |
$62.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$90.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$90.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.06
|
| 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 |
$62.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$90.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.16
|
| Rate for Payer: Molina Healthcare Passport |
$62.90
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$117.06
|
| Rate for Payer: UHCCP Medicaid |
$51.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$90.05
|
|
|
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 |
$91.82 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$208.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| 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 |
$80.10 |
| 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 |
$213.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$184.23
|
| Rate for Payer: PHCS Commercial |
$256.32
|
| Rate for Payer: United Healthcare All Payer |
$234.96
|
|
|
PT2 GUIDE WIRE 180CM
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem Medicaid |
$409.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Humana KY Medicaid |
$409.24
|
| Rate for Payer: Kentucky WC Medicaid |
$413.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.10
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
PT2 GUIDE WIRE 180CM
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,142.40 |
| Rate for Payer: Aetna Commercial |
$916.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.20
|
| Rate for Payer: Cash Price |
$595.00
|
| Rate for Payer: Cigna Commercial |
$987.70
|
| Rate for Payer: First Health Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial |
$1,011.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.20
|
| Rate for Payer: Ohio Health Group HMO |
$892.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.10
|
| Rate for Payer: PHCS Commercial |
$1,142.40
|
| Rate for Payer: United Healthcare All Payer |
$1,047.20
|
|
|
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 |
$3,784.20 |
| Rate for Payer: Ambetter Exchange |
$137.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.57
|
| Rate for Payer: Anthem Medicaid |
$477.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.52
|
| 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 |
$477.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.01
|
| Rate for Payer: Molina Healthcare Passport |
$477.46
|
| Rate for Payer: Multiplan PHCS |
$3,784.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.23
|
| Rate for Payer: UHCCP Medicaid |
$128.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.10
|
|
|
PTA VENOUS
|
Facility
|
IP
|
$6,307.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
76101571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.10 |
| 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 |
$5,045.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,487.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,351.83
|
| 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 |
$1,787.10 |
| 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 |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,787.10 |
| 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 |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
48100039
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,787.10 |
| 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 |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS
|
Facility
|
OP
|
$6,307.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
76101571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,892.10 |
| Max. Negotiated Rate |
$6,054.72 |
| Rate for Payer: Aetna Commercial |
$4,856.39
|
| Rate for Payer: Anthem Medicaid |
$2,168.98
|
| 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: Humana KY Medicaid |
$2,168.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,191.05
|
| 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: Molina Healthcare Medicaid |
$2,212.50
|
| 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 |
$5,045.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,487.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,351.83
|
| Rate for Payer: PHCS Commercial |
$6,054.72
|
| Rate for Payer: United Healthcare All Payer |
$5,550.16
|
|
|
PTA VENOUS
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
36000074
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,787.10 |
| 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 |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTA VENOUS(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
761P1571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.57 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Ambetter Exchange |
$137.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.57
|
| Rate for Payer: Anthem Medicaid |
$477.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$137.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$137.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.52
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$275.28
|
| Rate for Payer: Humana Medicaid |
$477.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$194.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$137.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$487.01
|
| Rate for Payer: Molina Healthcare Passport |
$477.46
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.23
|
| Rate for Payer: UHCCP Medicaid |
$128.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$482.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$137.10
|
|
|
PTA VENOUS(T
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
761T1571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,787.10 |
| 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 |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
