|
PT HYBRID GLEN POST-REGENEREX
|
Facility
|
IP
|
$3,623.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.12 |
| Max. Negotiated Rate |
$3,478.80 |
| Rate for Payer: Aetna Commercial |
$2,790.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,826.53
|
| Rate for Payer: Cash Price |
$1,811.88
|
| Rate for Payer: Cigna Commercial |
$3,007.71
|
| Rate for Payer: First Health Commercial |
$3,442.56
|
| Rate for Payer: Humana Commercial |
$3,080.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,971.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,188.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,717.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,899.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,152.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,500.39
|
| Rate for Payer: PHCS Commercial |
$3,478.80
|
| Rate for Payer: United Healthcare All Payer |
$3,188.90
|
|
|
PT RE EVAL CARE PLAN
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 97164
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem Medicaid |
$43.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Humana KY Medicaid |
$43.33
|
| Rate for Payer: Kentucky WC Medicaid |
$43.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
PT RE EVAL CARE PLAN
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 97164
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$120.96 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.28
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$104.58
|
| Rate for Payer: First Health Commercial |
$119.70
|
| Rate for Payer: Humana Commercial |
$107.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$103.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.88
|
| Rate for Payer: Ohio Health Group HMO |
$94.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.94
|
| Rate for Payer: PHCS Commercial |
$120.96
|
| Rate for Payer: United Healthcare All Payer |
$110.88
|
|
|
PT SELF CARE
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem Medicaid |
$37.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Humana KY Medicaid |
$37.49
|
| Rate for Payer: Kentucky WC Medicaid |
$37.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$38.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
PT SELF CARE
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$104.64 |
| Rate for Payer: Aetna Commercial |
$83.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$85.02
|
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Cigna Commercial |
$90.47
|
| Rate for Payer: First Health Commercial |
$103.55
|
| Rate for Payer: Humana Commercial |
$92.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$89.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$80.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.92
|
| Rate for Payer: Ohio Health Group HMO |
$81.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$87.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$94.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.21
|
| Rate for Payer: PHCS Commercial |
$104.64
|
| Rate for Payer: United Healthcare All Payer |
$95.92
|
|
|
PTT-ACTIVATE PLASMA OR WH BLD
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
30000630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$6.01
|
| Rate for Payer: Humana Medicare Advantage |
$6.01
|
| Rate for Payer: Kentucky WC Medicaid |
$6.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
PTT-ACTIVATE PLASMA OR WH BLD
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
30000630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
PTT SUBS PLASMA FRACTIONS EA
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.12
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
PTT SUBS PLASMA FRACTIONS EA
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$198.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$171.12
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
PT WHEELCHAIR TRAINING 15 MIN
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
42000032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
PT WHEELCHAIR TRAINING 15 MIN
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
42000032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.32 |
| Rate for Payer: Aetna Commercial |
$51.59
|
| Rate for Payer: Anthem Medicaid |
$23.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.26
|
| Rate for Payer: Cash Price |
$33.50
|
| Rate for Payer: Cigna Commercial |
$55.61
|
| Rate for Payer: First Health Commercial |
$63.65
|
| Rate for Payer: Humana Commercial |
$56.95
|
| Rate for Payer: Humana KY Medicaid |
$23.04
|
| Rate for Payer: Kentucky WC Medicaid |
$23.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.96
|
| Rate for Payer: Ohio Health Group HMO |
$50.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.23
|
| Rate for Payer: PHCS Commercial |
$64.32
|
| Rate for Payer: United Healthcare All Payer |
$58.96
|
|
|
PULM FUNCTION DISABILITY
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$203.52 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.36
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.28
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
PULM FUNCTION DISABILITY
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$72.91 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Anthem Medicaid |
$72.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$165.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cash Price |
$106.00
|
| Rate for Payer: Cigna Commercial |
$175.96
|
| Rate for Payer: First Health Commercial |
$201.40
|
| Rate for Payer: Humana Commercial |
$180.20
|
| Rate for Payer: Humana KY Medicaid |
$72.91
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$73.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$173.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$156.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$74.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$186.56
|
| Rate for Payer: Ohio Health Group HMO |
$159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$169.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$184.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$146.28
|
| Rate for Payer: PHCS Commercial |
$203.52
|
| Rate for Payer: United Healthcare All Payer |
$186.56
|
|
|
PULM FUNCTION DISABILITY 2
|
Facility
|
OP
|
$199.00
|
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
469
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
PULM FUNCTION DISABILITY 2
|
Facility
|
IP
|
$199.00
|
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
469
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$159.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$173.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.31
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
PULM FUNCT TEST OSCILLOMETR(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
460P0014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$69.47 |
| Rate for Payer: Ambetter Exchange |
$40.02
|
| Rate for Payer: Anthem Medicaid |
$30.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.02
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$69.47
|
| Rate for Payer: Healthspan PPO |
$35.92
|
| Rate for Payer: Humana Medicaid |
$30.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.27
|
| Rate for Payer: Molina Healthcare Passport |
$30.66
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.03
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.02
|
|
|
PULM FUNCT TEST OSCILLOMETR(T
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
460T0014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$128.10 |
| Max. Negotiated Rate |
$409.92 |
| Rate for Payer: Aetna Commercial |
$328.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.06
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cigna Commercial |
$354.41
|
| Rate for Payer: First Health Commercial |
$405.65
|
| Rate for Payer: Humana Commercial |
$362.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.76
|
| Rate for Payer: Ohio Health Group HMO |
$320.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.63
|
| Rate for Payer: PHCS Commercial |
$409.92
|
| Rate for Payer: United Healthcare All Payer |
$375.76
|
|
|
PULM FUNCT TEST OSCILLOMETR(T
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
460T0014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$409.92 |
| Rate for Payer: Aetna Commercial |
$328.79
|
| Rate for Payer: Anthem Medicaid |
$146.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$333.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cash Price |
$213.50
|
| Rate for Payer: Cigna Commercial |
$354.41
|
| Rate for Payer: First Health Commercial |
$405.65
|
| Rate for Payer: Humana Commercial |
$362.95
|
| Rate for Payer: Humana KY Medicaid |
$146.85
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$148.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$350.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$315.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.76
|
| Rate for Payer: Ohio Health Group HMO |
$320.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.63
|
| Rate for Payer: PHCS Commercial |
$409.92
|
| Rate for Payer: United Healthcare All Payer |
$375.76
|
|
|
PULM FUNCT TEST OSCILLOMETRY
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna Commercial |
$367.29
|
| Rate for Payer: Anthem Medicaid |
$164.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$395.91
|
| Rate for Payer: First Health Commercial |
$453.15
|
| Rate for Payer: Humana Commercial |
$405.45
|
| Rate for Payer: Humana KY Medicaid |
$164.04
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$165.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$167.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$419.76
|
| Rate for Payer: Ohio Health Group HMO |
$357.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.13
|
| Rate for Payer: PHCS Commercial |
$457.92
|
| Rate for Payer: United Healthcare All Payer |
$419.76
|
|
|
PULM FUNCT TEST OSCILLOMETRY
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$286.20 |
| Rate for Payer: Ambetter Exchange |
$40.02
|
| Rate for Payer: Anthem Medicaid |
$30.66
|
| Rate for Payer: Buckeye Individual/Medicaid |
$40.02
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$48.02
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$69.47
|
| Rate for Payer: Healthspan PPO |
$35.92
|
| Rate for Payer: Humana Medicaid |
$30.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$40.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.27
|
| Rate for Payer: Molina Healthcare Passport |
$30.66
|
| Rate for Payer: Multiplan PHCS |
$286.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.03
|
| Rate for Payer: UHCCP Medicaid |
$166.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$40.02
|
|
|
PULM FUNCT TEST OSCILLOMETRY
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$143.10 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna Commercial |
$367.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$372.06
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$395.91
|
| Rate for Payer: First Health Commercial |
$453.15
|
| Rate for Payer: Humana Commercial |
$405.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$391.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$352.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$143.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$419.76
|
| Rate for Payer: Ohio Health Group HMO |
$357.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$329.13
|
| Rate for Payer: PHCS Commercial |
$457.92
|
| Rate for Payer: United Healthcare All Payer |
$419.76
|
|
|
PULM FUNCT TST PLETHYSMOGRA(P
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
460P0012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$88.27 |
| Rate for Payer: Ambetter Exchange |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$41.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.15
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$88.27
|
| Rate for Payer: Healthspan PPO |
$45.66
|
| Rate for Payer: Humana Medicaid |
$41.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.33
|
| Rate for Payer: Molina Healthcare Passport |
$41.50
|
| Rate for Payer: Multiplan PHCS |
$57.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.25
|
| Rate for Payer: UHCCP Medicaid |
$33.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.96
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Ambetter Exchange |
$50.96
|
| Rate for Payer: Anthem Medicaid |
$41.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$61.15
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$88.27
|
| Rate for Payer: Healthspan PPO |
$45.66
|
| Rate for Payer: Humana Medicaid |
$41.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.96
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$42.33
|
| Rate for Payer: Molina Healthcare Passport |
$41.50
|
| Rate for Payer: Multiplan PHCS |
$588.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$66.25
|
| Rate for Payer: UHCCP Medicaid |
$343.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$41.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.96
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$294.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
|
PULM FUNCT TST PLETHYSMOGRAP
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
HCPCS 94726
|
| Hospital Charge Code |
46000012
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$940.80 |
| Rate for Payer: Aetna Commercial |
$754.60
|
| Rate for Payer: Anthem Medicaid |
$337.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$764.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cash Price |
$490.00
|
| Rate for Payer: Cigna Commercial |
$813.40
|
| Rate for Payer: First Health Commercial |
$931.00
|
| Rate for Payer: Humana Commercial |
$833.00
|
| Rate for Payer: Humana KY Medicaid |
$337.02
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$340.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$803.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$723.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$343.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$862.40
|
| Rate for Payer: Ohio Health Group HMO |
$735.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.20
|
| Rate for Payer: PHCS Commercial |
$940.80
|
| Rate for Payer: United Healthcare All Payer |
$862.40
|
|
