|
BEDSIDE BRONCHOSCOPY
|
Facility
|
OP
|
$3,207.00
|
|
| Hospital Charge Code |
76102538
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.10 |
| Max. Negotiated Rate |
$3,078.72 |
| Rate for Payer: Aetna Commercial |
$2,469.39
|
| Rate for Payer: Anthem Medicaid |
$1,102.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.46
|
| Rate for Payer: Cash Price |
$1,603.50
|
| Rate for Payer: Cigna Commercial |
$2,661.81
|
| Rate for Payer: First Health Commercial |
$3,046.65
|
| Rate for Payer: Humana Commercial |
$2,725.95
|
| Rate for Payer: Humana KY Medicaid |
$1,102.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,114.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,125.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.83
|
| Rate for Payer: PHCS Commercial |
$3,078.72
|
| Rate for Payer: United Healthcare All Payer |
$2,822.16
|
|
|
BEDSIDE COLONOSCOPY
|
Facility
|
OP
|
$3,690.00
|
|
| Hospital Charge Code |
76102540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem Medicaid |
$1,268.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Humana KY Medicaid |
$1,268.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,294.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
BEDSIDE COLONOSCOPY
|
Facility
|
IP
|
$3,690.00
|
|
| Hospital Charge Code |
76102540
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,107.00 |
| Max. Negotiated Rate |
$3,542.40 |
| Rate for Payer: Aetna Commercial |
$2,841.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,878.20
|
| Rate for Payer: Cash Price |
$1,845.00
|
| Rate for Payer: Cigna Commercial |
$3,062.70
|
| Rate for Payer: First Health Commercial |
$3,505.50
|
| Rate for Payer: Humana Commercial |
$3,136.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,025.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,723.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,107.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,247.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,767.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,952.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,210.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,546.10
|
| Rate for Payer: PHCS Commercial |
$3,542.40
|
| Rate for Payer: United Healthcare All Payer |
$3,247.20
|
|
|
BEDSIDE ECMO
|
Facility
|
OP
|
$8,745.00
|
|
| Hospital Charge Code |
76102541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,623.50 |
| Max. Negotiated Rate |
$8,395.20 |
| Rate for Payer: Aetna Commercial |
$6,733.65
|
| Rate for Payer: Anthem Medicaid |
$3,007.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.10
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Cigna Commercial |
$7,258.35
|
| Rate for Payer: First Health Commercial |
$8,307.75
|
| Rate for Payer: Humana Commercial |
$7,433.25
|
| Rate for Payer: Humana KY Medicaid |
$3,007.41
|
| Rate for Payer: Kentucky WC Medicaid |
$3,038.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,067.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.05
|
| Rate for Payer: PHCS Commercial |
$8,395.20
|
| Rate for Payer: United Healthcare All Payer |
$7,695.60
|
|
|
BEDSIDE ECMO
|
Facility
|
IP
|
$8,745.00
|
|
| Hospital Charge Code |
76102541
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,623.50 |
| Max. Negotiated Rate |
$8,395.20 |
| Rate for Payer: Aetna Commercial |
$6,733.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,821.10
|
| Rate for Payer: Cash Price |
$4,372.50
|
| Rate for Payer: Cigna Commercial |
$7,258.35
|
| Rate for Payer: First Health Commercial |
$8,307.75
|
| Rate for Payer: Humana Commercial |
$7,433.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,170.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,453.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,623.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,695.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,558.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,608.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,034.05
|
| Rate for Payer: PHCS Commercial |
$8,395.20
|
| Rate for Payer: United Healthcare All Payer |
$7,695.60
|
|
|
BEDSIDE EGD
|
Facility
|
IP
|
$3,207.00
|
|
| Hospital Charge Code |
76102539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.10 |
| Max. Negotiated Rate |
$3,078.72 |
| Rate for Payer: Aetna Commercial |
$2,469.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.46
|
| Rate for Payer: Cash Price |
$1,603.50
|
| Rate for Payer: Cigna Commercial |
$2,661.81
|
| Rate for Payer: First Health Commercial |
$3,046.65
|
| Rate for Payer: Humana Commercial |
$2,725.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.83
|
| Rate for Payer: PHCS Commercial |
$3,078.72
|
| Rate for Payer: United Healthcare All Payer |
$2,822.16
|
|
|
BEDSIDE EGD
|
Facility
|
OP
|
$3,207.00
|
|
| Hospital Charge Code |
76102539
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$962.10 |
| Max. Negotiated Rate |
$3,078.72 |
| Rate for Payer: Aetna Commercial |
$2,469.39
|
| Rate for Payer: Anthem Medicaid |
$1,102.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.46
|
| Rate for Payer: Cash Price |
$1,603.50
|
| Rate for Payer: Cigna Commercial |
$2,661.81
|
| Rate for Payer: First Health Commercial |
$3,046.65
|
| Rate for Payer: Humana Commercial |
$2,725.95
|
| Rate for Payer: Humana KY Medicaid |
$1,102.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,114.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,125.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.83
|
| Rate for Payer: PHCS Commercial |
$3,078.72
|
| Rate for Payer: United Healthcare All Payer |
$2,822.16
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
76102494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Ambetter Exchange |
$24.73
|
| Rate for Payer: Anthem Medicaid |
$24.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Healthspan PPO |
$38.69
|
| Rate for Payer: Humana Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.93
|
| Rate for Payer: Molina Healthcare Passport |
$24.44
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.15
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.73
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
76102494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem Medicaid |
$79.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Humana KY Medicaid |
$79.78
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$80.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.08
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
76102494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
BEDSIDE-SPIROMETRY/EACH
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
46000001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.96
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.08
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
BEDSIDE-SPIROMETRY/EACH(P
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
761P2494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$49.95 |
| Rate for Payer: Aetna Commercial |
$49.95
|
| Rate for Payer: Ambetter Exchange |
$24.73
|
| Rate for Payer: Anthem Medicaid |
$24.44
|
| Rate for Payer: Buckeye Individual/Medicaid |
$24.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$24.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$48.60
|
| Rate for Payer: Healthspan PPO |
$38.69
|
| Rate for Payer: Humana Medicaid |
$24.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$24.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.93
|
| Rate for Payer: Molina Healthcare Passport |
$24.44
|
| Rate for Payer: Multiplan PHCS |
$28.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$32.15
|
| Rate for Payer: UHCCP Medicaid |
$16.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$24.73
|
|
|
BEDSIDE-SPIROMETRY/EACH(T
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
761T2494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem Medicaid |
$79.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Humana KY Medicaid |
$79.78
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$80.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.08
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
BEDSIDE-SPIROMETRY/EACH(T
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
HCPCS 94010
|
| Hospital Charge Code |
761T2494
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$222.72 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$180.96
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cigna Commercial |
$192.56
|
| Rate for Payer: First Health Commercial |
$220.40
|
| Rate for Payer: Humana Commercial |
$197.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$190.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$171.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$204.16
|
| Rate for Payer: Ohio Health Group HMO |
$174.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$185.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.08
|
| Rate for Payer: PHCS Commercial |
$222.72
|
| Rate for Payer: United Healthcare All Payer |
$204.16
|
|
|
BEECH TREE IGE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BEECH TREE IGE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
30000728
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$5.22
|
| Rate for Payer: Humana Medicare Advantage |
$5.22
|
| Rate for Payer: Kentucky WC Medicaid |
$5.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.61
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MI
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MI
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Ambetter Exchange |
$28.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$34.09
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.41
|
| Rate for Payer: Multiplan PHCS |
$96.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.93
|
| Rate for Payer: UHCCP Medicaid |
$56.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.41
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MI
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
51000349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$153.60 |
| Rate for Payer: Aetna Commercial |
$123.20
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cigna Commercial |
$132.80
|
| Rate for Payer: First Health Commercial |
$152.00
|
| Rate for Payer: Humana Commercial |
$136.00
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.80
|
| Rate for Payer: Ohio Health Group HMO |
$120.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$128.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$110.40
|
| Rate for Payer: PHCS Commercial |
$153.60
|
| Rate for Payer: United Healthcare All Payer |
$140.80
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
90000019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem Medicaid |
$65.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Humana KY Medicaid |
$65.00
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$65.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
90000019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$181.44 |
| Rate for Payer: Aetna Commercial |
$145.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$147.42
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$156.87
|
| Rate for Payer: First Health Commercial |
$179.55
|
| Rate for Payer: Humana Commercial |
$160.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$154.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$139.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$56.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$166.32
|
| Rate for Payer: Ohio Health Group HMO |
$141.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$130.41
|
| Rate for Payer: PHCS Commercial |
$181.44
|
| Rate for Payer: United Healthcare All Payer |
$166.32
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
90000019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.63
|
| Rate for Payer: Multiplan PHCS |
$113.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$132.30
|
| Rate for Payer: UHCCP Medicaid |
$66.15
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
900P0019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$49.63
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
|
|
BEHAVIOR ID ASSMNT BY A PHYS(T
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 97151
|
| Hospital Charge Code |
900T0019
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$13.41 |
| Max. Negotiated Rate |
$119.66 |
| Rate for Payer: Aetna Commercial |
$30.03
|
| Rate for Payer: Anthem Medicaid |
$13.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$85.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$30.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$119.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$115.38
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cash Price |
$19.50
|
| Rate for Payer: Cigna Commercial |
$32.37
|
| Rate for Payer: First Health Commercial |
$37.05
|
| Rate for Payer: Humana Commercial |
$33.15
|
| Rate for Payer: Humana KY Medicaid |
$13.41
|
| Rate for Payer: Humana Medicare Advantage |
$85.47
|
| Rate for Payer: Kentucky WC Medicaid |
$13.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$31.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$28.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$13.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$34.32
|
| Rate for Payer: Ohio Health Group HMO |
$29.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$31.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$26.91
|
| Rate for Payer: PHCS Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Payer |
$34.32
|
|
