|
SYNCH AUDIO-ONLY EST LOW 20
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
HCPCS 98013
|
| Hospital Charge Code |
96000047
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.59
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
SYNCH AUDIO-ONLY EST MOD 30
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 98014
|
| Hospital Charge Code |
96000048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$75.25 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Anthem Medicaid |
$76.83
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Humana Medicaid |
$76.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$78.37
|
| Rate for Payer: Molina Healthcare Passport |
$76.83
|
| Rate for Payer: Multiplan PHCS |
$129.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.50
|
| Rate for Payer: UHCCP Medicaid |
$75.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.60
|
|
|
SYNCH AUDIO-ONLY EST MOD 30
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 98014
|
| Hospital Charge Code |
96000048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem Medicaid |
$73.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Humana KY Medicaid |
$73.94
|
| Rate for Payer: Kentucky WC Medicaid |
$74.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
SYNCH AUDIO-ONLY EST MOD 30
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 98014
|
| Hospital Charge Code |
96000048
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$206.40 |
| Rate for Payer: Aetna Commercial |
$165.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$167.70
|
| Rate for Payer: Cash Price |
$107.50
|
| Rate for Payer: Cigna Commercial |
$178.45
|
| Rate for Payer: First Health Commercial |
$204.25
|
| Rate for Payer: Humana Commercial |
$182.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$176.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$158.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$189.20
|
| Rate for Payer: Ohio Health Group HMO |
$161.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$148.35
|
| Rate for Payer: PHCS Commercial |
$206.40
|
| Rate for Payer: United Healthcare All Payer |
$189.20
|
|
|
SYNCH AUDIO-ONLY EST SF 10
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 98012
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
SYNCH AUDIO-ONLY EST SF 10
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 98012
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
SYNCH AUDIO-ONLY EST SF 10
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 98012
|
| Hospital Charge Code |
96000046
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Anthem Medicaid |
$30.03
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Humana Medicaid |
$30.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$30.63
|
| Rate for Payer: Molina Healthcare Passport |
$30.03
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.33
|
|
|
SYNCH AUDIO-ONLY NEW HIGH 60
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 98011
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$135.67 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Anthem Medicaid |
$135.67
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Humana Medicaid |
$135.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$138.38
|
| Rate for Payer: Molina Healthcare Passport |
$135.67
|
| Rate for Payer: Multiplan PHCS |
$234.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.00
|
| Rate for Payer: UHCCP Medicaid |
$136.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$137.03
|
|
|
SYNCH AUDIO-ONLY NEW HIGH 60
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS 98011
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.10
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
SYNCH AUDIO-ONLY NEW HIGH 60
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS 98011
|
| Hospital Charge Code |
96000045
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$300.30
|
| Rate for Payer: Anthem Medicaid |
$134.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.20
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$323.70
|
| Rate for Payer: First Health Commercial |
$370.50
|
| Rate for Payer: Humana Commercial |
$331.50
|
| Rate for Payer: Humana KY Medicaid |
$134.12
|
| Rate for Payer: Kentucky WC Medicaid |
$135.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$319.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$287.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$343.20
|
| Rate for Payer: Ohio Health Group HMO |
$292.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$339.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.10
|
| Rate for Payer: PHCS Commercial |
$374.40
|
| Rate for Payer: United Healthcare All Payer |
$343.20
|
|
|
SYNCH AUDIO-ONLY NEW LOW 30
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 98009
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Anthem Medicaid |
$66.92
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Humana Medicaid |
$66.92
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$68.26
|
| Rate for Payer: Molina Healthcare Passport |
$66.92
|
| Rate for Payer: Multiplan PHCS |
$114.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$133.00
|
| Rate for Payer: UHCCP Medicaid |
$66.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$67.59
|
|
|
SYNCH AUDIO-ONLY NEW LOW 30
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 98009
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem Medicaid |
$65.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Humana KY Medicaid |
$65.34
|
| Rate for Payer: Kentucky WC Medicaid |
$66.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
SYNCH AUDIO-ONLY NEW LOW 30
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 98009
|
| Hospital Charge Code |
96000043
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
SYNCH AUDIO-ONLY NEW MOD 45
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 98010
|
| Hospital Charge Code |
96000044
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Anthem Medicaid |
$104.30
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Humana Medicaid |
$104.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$106.39
|
| Rate for Payer: Molina Healthcare Passport |
$104.30
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$105.34
|
|
|
SYNCH AUDIO-ONLY NEW SF 15
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS 98008
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
SYNCH AUDIO-ONLY NEW SF 15
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS 98008
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
SYNCH AUDIO-ONLY NEW SF 15
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 98008
|
| Hospital Charge Code |
96000042
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Anthem Medicaid |
$40.28
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Humana Medicaid |
$40.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.09
|
| Rate for Payer: Molina Healthcare Passport |
$40.28
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.68
|
|
|
SYNCH AUDIO-VIDEO EST HI 40
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 98007
|
| Hospital Charge Code |
96000058
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$112.55 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Anthem Medicaid |
$112.55
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Cash Price |
$162.50
|
| Rate for Payer: Humana Medicaid |
$112.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.80
|
| Rate for Payer: Molina Healthcare Passport |
$112.55
|
| Rate for Payer: Multiplan PHCS |
$195.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$227.50
|
| Rate for Payer: UHCCP Medicaid |
$113.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.68
|
|
|
SYNCH AUDIO-VIDEO EST LOW 20
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 98005
|
| Hospital Charge Code |
96000056
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$57.44 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: Anthem Medicaid |
$57.44
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Humana Medicaid |
$57.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$58.59
|
| Rate for Payer: Molina Healthcare Passport |
$57.44
|
| Rate for Payer: Multiplan PHCS |
$99.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$115.50
|
| Rate for Payer: UHCCP Medicaid |
$57.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$58.01
|
|
|
SYNCH AUDIO-VIDEO EST MOD 30
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 98006
|
| Hospital Charge Code |
96000057
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Anthem Medicaid |
$84.81
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Humana Medicaid |
$84.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.51
|
| Rate for Payer: Molina Healthcare Passport |
$84.81
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.66
|
|
|
SYNCH AUDIO-VIDEO EST SF 10
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 98004
|
| Hospital Charge Code |
96000055
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Anthem Medicaid |
$32.75
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Humana Medicaid |
$32.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.41
|
| Rate for Payer: Molina Healthcare Passport |
$32.75
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$63.00
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.08
|
|
|
SYNCH AUDIO-VIDEO NEW HI 60
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 98003
|
| Hospital Charge Code |
96000054
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Anthem Medicaid |
$148.68
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Humana Medicaid |
$148.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$151.65
|
| Rate for Payer: Molina Healthcare Passport |
$148.68
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$150.17
|
|
|
SYNCH AUDIO-VIDEO NEW LOW 30
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 98001
|
| Hospital Charge Code |
96000052
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Anthem Medicaid |
$70.19
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Humana Medicaid |
$70.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.59
|
| Rate for Payer: Molina Healthcare Passport |
$70.19
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.89
|
|
|
SYNCH AUDIO-VIDEO NEW MOD 45
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 98002
|
| Hospital Charge Code |
96000053
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Anthem Medicaid |
$112.03
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Humana Medicaid |
$112.03
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$114.27
|
| Rate for Payer: Molina Healthcare Passport |
$112.03
|
| Rate for Payer: Multiplan PHCS |
$189.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$220.50
|
| Rate for Payer: UHCCP Medicaid |
$110.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$113.15
|
|
|
SYNCH AUDIO-VIDEO NEW SF 15
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 98000
|
| Hospital Charge Code |
96000051
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Anthem Medicaid |
$42.44
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Humana Medicaid |
$42.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.29
|
| Rate for Payer: Molina Healthcare Passport |
$42.44
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.86
|
|
