|
SPECTRA IMP PULS GEN KIT
|
Facility
|
IP
|
$91,440.00
|
|
|
Service Code
|
HCPCS C1820
|
| Hospital Charge Code |
27000082
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,432.00 |
| Max. Negotiated Rate |
$87,782.40 |
| Rate for Payer: Aetna Commercial |
$70,408.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71,323.20
|
| Rate for Payer: Cash Price |
$45,720.00
|
| Rate for Payer: Cigna Commercial |
$75,895.20
|
| Rate for Payer: First Health Commercial |
$86,868.00
|
| Rate for Payer: Humana Commercial |
$77,724.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$74,980.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67,482.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27,432.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$80,467.20
|
| Rate for Payer: Ohio Health Group HMO |
$68,580.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73,152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79,552.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63,093.60
|
| Rate for Payer: PHCS Commercial |
$87,782.40
|
| Rate for Payer: United Healthcare All Payer |
$80,467.20
|
|
|
SPECTRON EF SHELL 48MM
|
Facility
|
OP
|
$4,808.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.46 |
| Max. Negotiated Rate |
$4,615.86 |
| Rate for Payer: Aetna Commercial |
$3,702.31
|
| Rate for Payer: Anthem Medicaid |
$1,653.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,750.39
|
| Rate for Payer: Cash Price |
$2,404.09
|
| Rate for Payer: Cigna Commercial |
$3,990.80
|
| Rate for Payer: First Health Commercial |
$4,567.78
|
| Rate for Payer: Humana Commercial |
$4,086.96
|
| Rate for Payer: Humana KY Medicaid |
$1,653.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,548.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,231.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,606.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,846.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,183.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.65
|
| Rate for Payer: PHCS Commercial |
$4,615.86
|
| Rate for Payer: United Healthcare All Payer |
$4,231.21
|
|
|
SPECTRON EF SHELL 48MM
|
Facility
|
IP
|
$4,808.19
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.46 |
| Max. Negotiated Rate |
$4,615.86 |
| Rate for Payer: Aetna Commercial |
$3,702.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,750.39
|
| Rate for Payer: Cash Price |
$2,404.09
|
| Rate for Payer: Cigna Commercial |
$3,990.80
|
| Rate for Payer: First Health Commercial |
$4,567.78
|
| Rate for Payer: Humana Commercial |
$4,086.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,548.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,231.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,606.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,846.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,183.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.65
|
| Rate for Payer: PHCS Commercial |
$4,615.86
|
| Rate for Payer: United Healthcare All Payer |
$4,231.21
|
|
|
SPEECH AUDIOMETRY
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
47000011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
SPEECH AUDIOMETRY
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
47000011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$59.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$59.84
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$60.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
SPEECH AUDIOMETRY
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
47000011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna Commercial |
$24.25
|
| Rate for Payer: Ambetter Exchange |
$26.86
|
| Rate for Payer: Anthem Medicaid |
$10.63
|
| Rate for Payer: Buckeye Individual/Medicaid |
$26.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$26.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$32.23
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$23.84
|
| Rate for Payer: Healthspan PPO |
$19.85
|
| Rate for Payer: Humana Medicaid |
$10.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.24
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$26.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$10.84
|
| Rate for Payer: Molina Healthcare Passport |
$10.63
|
| Rate for Payer: Multiplan PHCS |
$104.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$34.92
|
| Rate for Payer: UHCCP Medicaid |
$60.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$10.74
|
| Rate for Payer: Wellcare Medicare Advantage |
$26.86
|
|
|
SPEECH AUDIOMETRY(T
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
470T0011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem Medicaid |
$59.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Humana KY Medicaid |
$59.84
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$60.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
SPEECH AUDIOMETRY(T
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
HCPCS 92555
|
| Hospital Charge Code |
470T0011
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$167.04 |
| Rate for Payer: Aetna Commercial |
$133.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$135.72
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$144.42
|
| Rate for Payer: First Health Commercial |
$165.30
|
| Rate for Payer: Humana Commercial |
$147.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$142.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$128.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$153.12
|
| Rate for Payer: Ohio Health Group HMO |
$130.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.06
|
| Rate for Payer: PHCS Commercial |
$167.04
|
| Rate for Payer: United Healthcare All Payer |
$153.12
|
|
|
SPEECH EVAL FLUENCY
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS 92521
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem Medicaid |
$106.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Humana KY Medicaid |
$106.61
|
| Rate for Payer: Kentucky WC Medicaid |
$107.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$108.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
SPEECH EVAL FLUENCY
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS 92521
|
| Hospital Charge Code |
44000003
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$297.60 |
| Rate for Payer: Aetna Commercial |
$238.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$241.80
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$257.30
|
| Rate for Payer: First Health Commercial |
$294.50
|
| Rate for Payer: Humana Commercial |
$263.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$254.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$228.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$272.80
|
| Rate for Payer: Ohio Health Group HMO |
$232.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$248.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$213.90
|
| Rate for Payer: PHCS Commercial |
$297.60
|
| Rate for Payer: United Healthcare All Payer |
$272.80
|
|
|
SPEECH EVAL PRODUCT
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
HCPCS 92522
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Aetna Commercial |
$210.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$226.59
|
| Rate for Payer: First Health Commercial |
$259.35
|
| Rate for Payer: Humana Commercial |
$232.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.24
|
| Rate for Payer: Ohio Health Group HMO |
$204.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.37
|
| Rate for Payer: PHCS Commercial |
$262.08
|
| Rate for Payer: United Healthcare All Payer |
$240.24
|
|
|
SPEECH EVAL PRODUCT
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
HCPCS 92522
|
| Hospital Charge Code |
44000004
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$262.08 |
| Rate for Payer: Aetna Commercial |
$210.21
|
| Rate for Payer: Anthem Medicaid |
$93.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$212.94
|
| Rate for Payer: Cash Price |
$136.50
|
| Rate for Payer: Cigna Commercial |
$226.59
|
| Rate for Payer: First Health Commercial |
$259.35
|
| Rate for Payer: Humana Commercial |
$232.05
|
| Rate for Payer: Humana KY Medicaid |
$93.88
|
| Rate for Payer: Kentucky WC Medicaid |
$94.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$223.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.24
|
| Rate for Payer: Ohio Health Group HMO |
$204.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.37
|
| Rate for Payer: PHCS Commercial |
$262.08
|
| Rate for Payer: United Healthcare All Payer |
$240.24
|
|
|
SPEECH EVAL SOUND LANG COMP
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
HCPCS 92523
|
| Hospital Charge Code |
44000005
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem Medicaid |
$174.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Humana KY Medicaid |
$174.70
|
| Rate for Payer: Kentucky WC Medicaid |
$176.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$178.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.52
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
SPEECH EVAL SOUND LANG COMP
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
HCPCS 92523
|
| Hospital Charge Code |
44000005
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$152.40 |
| Max. Negotiated Rate |
$487.68 |
| Rate for Payer: Aetna Commercial |
$391.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$396.24
|
| Rate for Payer: Cash Price |
$254.00
|
| Rate for Payer: Cigna Commercial |
$421.64
|
| Rate for Payer: First Health Commercial |
$482.60
|
| Rate for Payer: Humana Commercial |
$431.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$416.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$374.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$152.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$447.04
|
| Rate for Payer: Ohio Health Group HMO |
$381.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$441.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.52
|
| Rate for Payer: PHCS Commercial |
$487.68
|
| Rate for Payer: United Healthcare All Payer |
$447.04
|
|
|
SPEECH GROUP THERAPY
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 92508
|
| Hospital Charge Code |
44000002
|
|
Hospital Revenue Code
|
443
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.41
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
SPEECH GROUP THERAPY
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 92508
|
| Hospital Charge Code |
44000002
|
|
Hospital Revenue Code
|
443
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$85.44 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Anthem Medicaid |
$30.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$69.42
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cigna Commercial |
$73.87
|
| Rate for Payer: First Health Commercial |
$84.55
|
| Rate for Payer: Humana Commercial |
$75.65
|
| Rate for Payer: Humana KY Medicaid |
$30.61
|
| Rate for Payer: Kentucky WC Medicaid |
$30.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$72.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$65.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$26.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$78.32
|
| Rate for Payer: Ohio Health Group HMO |
$66.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$71.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.41
|
| Rate for Payer: PHCS Commercial |
$85.44
|
| Rate for Payer: United Healthcare All Payer |
$78.32
|
|
|
SPEEDBRDG BIO-C IMP SYS 4.75MM
|
Facility
|
IP
|
$10,860.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.05 |
| Max. Negotiated Rate |
$10,425.77 |
| Rate for Payer: Aetna Commercial |
$8,362.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.94
|
| Rate for Payer: Cash Price |
$5,430.09
|
| Rate for Payer: Cigna Commercial |
$9,013.95
|
| Rate for Payer: First Health Commercial |
$10,317.17
|
| Rate for Payer: Humana Commercial |
$9,231.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,905.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,258.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,145.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,688.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,448.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,493.52
|
| Rate for Payer: PHCS Commercial |
$10,425.77
|
| Rate for Payer: United Healthcare All Payer |
$9,556.96
|
|
|
SPEEDBRDG BIO-C IMP SYS 4.75MM
|
Facility
|
OP
|
$10,860.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.05 |
| Max. Negotiated Rate |
$10,425.77 |
| Rate for Payer: Aetna Commercial |
$8,362.34
|
| Rate for Payer: Anthem Medicaid |
$3,734.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,470.94
|
| Rate for Payer: Cash Price |
$5,430.09
|
| Rate for Payer: Cigna Commercial |
$9,013.95
|
| Rate for Payer: First Health Commercial |
$10,317.17
|
| Rate for Payer: Humana Commercial |
$9,231.15
|
| Rate for Payer: Humana KY Medicaid |
$3,734.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,772.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,905.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,014.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,258.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,809.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,556.96
|
| Rate for Payer: Ohio Health Group HMO |
$8,145.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,688.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,448.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,493.52
|
| Rate for Payer: PHCS Commercial |
$10,425.77
|
| Rate for Payer: United Healthcare All Payer |
$9,556.96
|
|
|
SPERM COUNT MOTILITY AND COUNT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 89322
|
| Hospital Charge Code |
30001551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
SPERM COUNT MOTILITY AND COUNT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 89322
|
| Hospital Charge Code |
30001551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$123.84 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Anthem Medicaid |
$15.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$15.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$103.59
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$21.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$107.07
|
| Rate for Payer: First Health Commercial |
$122.55
|
| Rate for Payer: Humana Commercial |
$109.65
|
| Rate for Payer: Humana KY Medicaid |
$15.50
|
| Rate for Payer: Humana Medicare Advantage |
$15.50
|
| Rate for Payer: Kentucky WC Medicaid |
$15.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$105.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$95.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$113.52
|
| Rate for Payer: Ohio Health Group HMO |
$96.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.01
|
| Rate for Payer: PHCS Commercial |
$123.84
|
| Rate for Payer: United Healthcare All Payer |
$113.52
|
|
|
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 |
$1,080.52 |
| Rate for Payer: Aetna Commercial |
$1,080.52
|
| Rate for Payer: Ambetter Exchange |
$707.33
|
| Rate for Payer: Anthem Medicaid |
$406.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$848.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$707.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.33
|
| 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 |
$919.53
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.33
|
|
|
SPHINCTEROPLASTY
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
76101934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$420.00 |
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SPHINCTEROPLASTY
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
76101934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$481.46 |
| Max. Negotiated Rate |
$3,547.47 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,533.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,547.47
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,420.78
|
| 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 |
$2,533.91
|
| 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 |
$3,040.69
|
| 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 |
$1,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,218.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$966.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
SPHINCTEROPLASTY(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 46750
|
| Hospital Charge Code |
761P1934
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$406.25 |
| Max. Negotiated Rate |
$1,080.52 |
| Rate for Payer: Aetna Commercial |
$1,080.52
|
| Rate for Payer: Ambetter Exchange |
$707.33
|
| Rate for Payer: Anthem Medicaid |
$406.25
|
| Rate for Payer: Buckeye Individual/Medicaid |
$707.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$707.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$848.80
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$707.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.33
|
| 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 |
$919.53
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$410.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$707.33
|
|
|
SPHINCTEROTOMY ANAL DIV SPHINC
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 46080
|
| Hospital Charge Code |
76101913
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Ambetter Exchange |
$150.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.75
|
| Rate for Payer: Anthem Medicaid |
$136.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.80
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$212.14
|
| Rate for Payer: Healthspan PPO |
$269.72
|
| Rate for Payer: Humana Medicaid |
$136.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$201.25
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$150.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.27
|
| Rate for Payer: Molina Healthcare Passport |
$136.54
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.87
|
| Rate for Payer: UHCCP Medicaid |
$134.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.91
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.67
|
|
