|
SPEC REV 12/14 LS/NR DST CN 14
|
Facility
|
IP
|
$1,830.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.83 |
| Rate for Payer: Aetna Commercial |
$1,409.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.42
|
| Rate for Payer: Cash Price |
$915.01
|
| Rate for Payer: Cigna Commercial |
$1,518.92
|
| Rate for Payer: First Health Commercial |
$1,738.53
|
| Rate for Payer: Humana Commercial |
$1,555.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.31
|
| Rate for Payer: PHCS Commercial |
$1,756.83
|
| Rate for Payer: United Healthcare All Payer |
$1,610.43
|
|
|
SPEC REV 12/14 LS/NR DST CN 14
|
Facility
|
OP
|
$1,830.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.83 |
| Rate for Payer: Aetna Commercial |
$1,409.12
|
| Rate for Payer: Anthem Medicaid |
$629.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.42
|
| Rate for Payer: Cash Price |
$915.01
|
| Rate for Payer: Cigna Commercial |
$1,518.92
|
| Rate for Payer: First Health Commercial |
$1,738.53
|
| Rate for Payer: Humana Commercial |
$1,555.53
|
| Rate for Payer: Humana KY Medicaid |
$629.35
|
| Rate for Payer: Kentucky WC Medicaid |
$635.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.31
|
| Rate for Payer: PHCS Commercial |
$1,756.83
|
| Rate for Payer: United Healthcare All Payer |
$1,610.43
|
|
|
SPEC REV 12/14 LS/NR DST CN 16
|
Facility
|
OP
|
$1,830.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.83 |
| Rate for Payer: Aetna Commercial |
$1,409.12
|
| Rate for Payer: Anthem Medicaid |
$629.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.42
|
| Rate for Payer: Cash Price |
$915.01
|
| Rate for Payer: Cigna Commercial |
$1,518.92
|
| Rate for Payer: First Health Commercial |
$1,738.53
|
| Rate for Payer: Humana Commercial |
$1,555.53
|
| Rate for Payer: Humana KY Medicaid |
$629.35
|
| Rate for Payer: Kentucky WC Medicaid |
$635.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.31
|
| Rate for Payer: PHCS Commercial |
$1,756.83
|
| Rate for Payer: United Healthcare All Payer |
$1,610.43
|
|
|
SPEC REV 12/14 LS/NR DST CN 16
|
Facility
|
IP
|
$1,830.03
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$1,756.83 |
| Rate for Payer: Aetna Commercial |
$1,409.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.42
|
| Rate for Payer: Cash Price |
$915.01
|
| Rate for Payer: Cigna Commercial |
$1,518.92
|
| Rate for Payer: First Health Commercial |
$1,738.53
|
| Rate for Payer: Humana Commercial |
$1,555.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.43
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.31
|
| Rate for Payer: PHCS Commercial |
$1,756.83
|
| Rate for Payer: United Healthcare All Payer |
$1,610.43
|
|
|
SPECTRA IMP PULS GEN KIT
|
Facility
|
OP
|
$88,180.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,463.40 |
| Max. Negotiated Rate |
$84,652.80 |
| Rate for Payer: Aetna Commercial |
$67,898.60
|
| Rate for Payer: Anthem Medicaid |
$30,325.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,780.40
|
| Rate for Payer: Cash Price |
$44,090.00
|
| Rate for Payer: Cigna Commercial |
$73,189.40
|
| Rate for Payer: First Health Commercial |
$83,771.00
|
| Rate for Payer: Humana Commercial |
$74,953.00
|
| Rate for Payer: Humana KY Medicaid |
$30,325.10
|
| Rate for Payer: Kentucky WC Medicaid |
$30,633.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,307.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,076.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,454.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,933.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,598.40
|
| Rate for Payer: Ohio Health Group HMO |
$66,135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,335.80
|
| Rate for Payer: PHCS Commercial |
$84,652.80
|
| Rate for Payer: United Healthcare All Payer |
$77,598.40
|
|
|
SPECTRA IMP PULS GEN KIT
|
Facility
|
IP
|
$88,180.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,463.40 |
| Max. Negotiated Rate |
$84,652.80 |
| Rate for Payer: Aetna Commercial |
$67,898.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$68,780.40
|
| Rate for Payer: Cash Price |
$44,090.00
|
| Rate for Payer: Cigna Commercial |
$73,189.40
|
| Rate for Payer: First Health Commercial |
$83,771.00
|
| Rate for Payer: Humana Commercial |
$74,953.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72,307.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65,076.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26,454.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$77,598.40
|
| Rate for Payer: Ohio Health Group HMO |
$66,135.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,463.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27,335.80
|
| Rate for Payer: PHCS Commercial |
$84,652.80
|
| Rate for Payer: United Healthcare All Payer |
$77,598.40
|
|
|
SPECTRON EF SHELL 48MM
|
Facility
|
OP
|
$4,820.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.73 |
| Max. Negotiated Rate |
$4,628.14 |
| Rate for Payer: Aetna Commercial |
$3,712.15
|
| Rate for Payer: Anthem Medicaid |
$1,657.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,760.36
|
| Rate for Payer: Cash Price |
$2,410.49
|
| Rate for Payer: Cigna Commercial |
$4,001.41
|
| Rate for Payer: First Health Commercial |
$4,579.93
|
| Rate for Payer: Humana Commercial |
$4,097.83
|
| Rate for Payer: Humana KY Medicaid |
$1,657.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,674.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,953.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,557.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,446.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,691.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,242.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,615.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.50
|
| Rate for Payer: PHCS Commercial |
$4,628.14
|
| Rate for Payer: United Healthcare All Payer |
$4,242.46
|
|
|
SPECTRON EF SHELL 48MM
|
Facility
|
IP
|
$4,820.98
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$626.73 |
| Max. Negotiated Rate |
$4,628.14 |
| Rate for Payer: Aetna Commercial |
$3,712.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,760.36
|
| Rate for Payer: Cash Price |
$2,410.49
|
| Rate for Payer: Cigna Commercial |
$4,001.41
|
| Rate for Payer: First Health Commercial |
$4,579.93
|
| Rate for Payer: Humana Commercial |
$4,097.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,953.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,557.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,446.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,242.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,615.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$964.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$626.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,494.50
|
| Rate for Payer: PHCS Commercial |
$4,628.14
|
| Rate for Payer: United Healthcare All Payer |
$4,242.46
|
|
|
SPEECH AUDIOMETRY
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
47000011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
SPEECH AUDIOMETRY
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
47000011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
SPEECH AUDIOMETRY(T
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
470T0011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem Medicaid |
$56.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Humana KY Medicaid |
$56.06
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$56.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
SPEECH AUDIOMETRY(T
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
470T0011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$21.19 |
| Max. Negotiated Rate |
$156.48 |
| Rate for Payer: Aetna Commercial |
$125.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.14
|
| Rate for Payer: Cash Price |
$81.50
|
| Rate for Payer: Cigna Commercial |
$135.29
|
| Rate for Payer: First Health Commercial |
$154.85
|
| Rate for Payer: Humana Commercial |
$138.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.44
|
| Rate for Payer: Ohio Health Group HMO |
$122.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.53
|
| Rate for Payer: PHCS Commercial |
$156.48
|
| Rate for Payer: United Healthcare All Payer |
$143.44
|
|
|
SPEECH EVAL FLUENCY
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
HCPCS 92521
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Aetna Commercial |
$224.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.98
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$241.53
|
| Rate for Payer: First Health Commercial |
$276.45
|
| Rate for Payer: Humana Commercial |
$247.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.08
|
| Rate for Payer: Ohio Health Group HMO |
$218.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.21
|
| Rate for Payer: PHCS Commercial |
$279.36
|
| Rate for Payer: United Healthcare All Payer |
$256.08
|
|
|
SPEECH EVAL FLUENCY
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
HCPCS 92521
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Aetna Commercial |
$224.07
|
| Rate for Payer: Anthem Medicaid |
$100.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.98
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$241.53
|
| Rate for Payer: First Health Commercial |
$276.45
|
| Rate for Payer: Humana Commercial |
$247.35
|
| Rate for Payer: Humana KY Medicaid |
$100.07
|
| Rate for Payer: Kentucky WC Medicaid |
$101.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.08
|
| Rate for Payer: Ohio Health Group HMO |
$218.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.21
|
| Rate for Payer: PHCS Commercial |
$279.36
|
| Rate for Payer: United Healthcare All Payer |
$256.08
|
|
|
SPEECH EVAL PRODUCT
|
Facility
|
OP
|
$257.00
|
|
|
Service Code
|
HCPCS 92522
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem Medicaid |
$88.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Humana KY Medicaid |
$88.38
|
| Rate for Payer: Kentucky WC Medicaid |
$89.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.67
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SPEECH EVAL PRODUCT
|
Facility
|
IP
|
$257.00
|
|
|
Service Code
|
HCPCS 92522
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$33.41 |
| Max. Negotiated Rate |
$246.72 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.46
|
| Rate for Payer: Cash Price |
$128.50
|
| Rate for Payer: Cigna Commercial |
$213.31
|
| Rate for Payer: First Health Commercial |
$244.15
|
| Rate for Payer: Humana Commercial |
$218.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$210.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$189.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$226.16
|
| Rate for Payer: Ohio Health Group HMO |
$192.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.67
|
| Rate for Payer: PHCS Commercial |
$246.72
|
| Rate for Payer: United Healthcare All Payer |
$226.16
|
|
|
SPEECH EVAL SOUND LANG COMP
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
HCPCS 92523
|
| Hospital Charge Code |
44000005
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$62.01 |
| 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 |
$95.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.87
|
| Rate for Payer: PHCS Commercial |
$457.92
|
| Rate for Payer: United Healthcare All Payer |
$419.76
|
|
|
SPEECH EVAL SOUND LANG COMP
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
HCPCS 92523
|
| Hospital Charge Code |
44000005
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$62.01 |
| Max. Negotiated Rate |
$457.92 |
| Rate for Payer: Aetna Commercial |
$367.29
|
| Rate for Payer: Anthem Medicaid |
$164.04
|
| 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: Humana KY Medicaid |
$164.04
|
| 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 |
$143.10
|
| 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 |
$95.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$62.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$147.87
|
| Rate for Payer: PHCS Commercial |
$457.92
|
| Rate for Payer: United Healthcare All Payer |
$419.76
|
|
|
SPEECH GROUP THERAPY
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 92508
|
| Hospital Charge Code |
44000002
|
|
Hospital Revenue Code
|
443
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
SPEECH GROUP THERAPY
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 92508
|
| Hospital Charge Code |
44000002
|
|
Hospital Revenue Code
|
443
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$80.64 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Anthem Medicaid |
$28.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$65.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$69.72
|
| Rate for Payer: First Health Commercial |
$79.80
|
| Rate for Payer: Humana Commercial |
$71.40
|
| Rate for Payer: Humana KY Medicaid |
$28.89
|
| Rate for Payer: Kentucky WC Medicaid |
$29.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$68.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$61.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$25.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$73.92
|
| Rate for Payer: Ohio Health Group HMO |
$63.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.04
|
| Rate for Payer: PHCS Commercial |
$80.64
|
| Rate for Payer: United Healthcare All Payer |
$73.92
|
|
|
SPERM COUNT MOTILITY AND COUNT
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
HCPCS 89322
|
| Hospital Charge Code |
30001551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$117.31 |
| Rate for Payer: Aetna Commercial |
$94.09
|
| Rate for Payer: Anthem Medicaid |
$42.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.50
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cigna Commercial |
$101.43
|
| Rate for Payer: First Health Commercial |
$116.09
|
| Rate for Payer: Humana Commercial |
$103.87
|
| Rate for Payer: Humana KY Medicaid |
$42.02
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Kentucky WC Medicaid |
$42.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.54
|
| Rate for Payer: Ohio Health Group HMO |
$91.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.88
|
| Rate for Payer: PHCS Commercial |
$117.31
|
| Rate for Payer: United Healthcare All Payer |
$107.54
|
|
|
SPERM COUNT MOTILITY AND COUNT
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
HCPCS 89322
|
| Hospital Charge Code |
30001551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$117.31 |
| Rate for Payer: Aetna Commercial |
$94.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$98.13
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cigna Commercial |
$101.43
|
| Rate for Payer: First Health Commercial |
$116.09
|
| Rate for Payer: Humana Commercial |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$100.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$90.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$107.54
|
| Rate for Payer: Ohio Health Group HMO |
$91.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$37.88
|
| Rate for Payer: PHCS Commercial |
$117.31
|
| Rate for Payer: United Healthcare All Payer |
$107.54
|
|
|
SPHINCTEROPLASTY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
76101934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$3,399.27 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,428.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,399.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,277.87
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,428.05
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SPHINCTEROPLASTY
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
76101934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$1,080.52
|
| Rate for Payer: Anthem Medicaid |
$406.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$990.06
|
| Rate for Payer: Healthspan PPO |
$911.22
|
| Rate for Payer: Humana Medicaid |
$406.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$958.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$414.38
|
| Rate for Payer: Molina Healthcare Passport |
$406.25
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.31
|
|
|
SPHINCTEROPLASTY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
76101934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
