|
VISUAL FLD EXAM
|
Facility
|
OP
|
$251.50
|
|
|
Service Code
|
HCPCS 92081
|
| Hospital Charge Code |
76102448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$241.44 |
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: Anthem Medicaid |
$86.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$125.75
|
| Rate for Payer: Cash Price |
$125.75
|
| Rate for Payer: Cigna Commercial |
$208.75
|
| Rate for Payer: First Health Commercial |
$238.93
|
| Rate for Payer: Humana Commercial |
$213.78
|
| Rate for Payer: Humana KY Medicaid |
$86.49
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$87.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.32
|
| Rate for Payer: Ohio Health Group HMO |
$188.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$218.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.53
|
| Rate for Payer: PHCS Commercial |
$241.44
|
| Rate for Payer: United Healthcare All Payer |
$221.32
|
|
|
VISUAL FLD EXAM(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 92081
|
| Hospital Charge Code |
761P2448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Ambetter Exchange |
$30.41
|
| Rate for Payer: Anthem Medicaid |
$36.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.49
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$69.26
|
| Rate for Payer: Healthspan PPO |
$59.78
|
| Rate for Payer: Humana Medicaid |
$36.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.79
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$37.18
|
| Rate for Payer: Molina Healthcare Passport |
$36.45
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.53
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$36.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.41
|
|
|
VISUAL FLD EXAM(T
|
Facility
|
IP
|
$131.50
|
|
|
Service Code
|
HCPCS 92081
|
| Hospital Charge Code |
761T2448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$126.24 |
| Rate for Payer: Aetna Commercial |
$101.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.57
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cigna Commercial |
$109.14
|
| Rate for Payer: First Health Commercial |
$124.92
|
| Rate for Payer: Humana Commercial |
$111.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$39.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.72
|
| Rate for Payer: Ohio Health Group HMO |
$98.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.73
|
| Rate for Payer: PHCS Commercial |
$126.24
|
| Rate for Payer: United Healthcare All Payer |
$115.72
|
|
|
VISUAL FLD EXAM(T
|
Facility
|
OP
|
$131.50
|
|
|
Service Code
|
HCPCS 92081
|
| Hospital Charge Code |
761T2448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.22 |
| Max. Negotiated Rate |
$126.24 |
| Rate for Payer: Aetna Commercial |
$101.25
|
| Rate for Payer: Anthem Medicaid |
$45.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$102.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cash Price |
$65.75
|
| Rate for Payer: Cigna Commercial |
$109.14
|
| Rate for Payer: First Health Commercial |
$124.92
|
| Rate for Payer: Humana Commercial |
$111.78
|
| Rate for Payer: Humana KY Medicaid |
$45.22
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$45.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$107.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$97.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$115.72
|
| Rate for Payer: Ohio Health Group HMO |
$98.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.73
|
| Rate for Payer: PHCS Commercial |
$126.24
|
| Rate for Payer: United Healthcare All Payer |
$115.72
|
|
|
VITAL
|
Facility
|
OP
|
$69.48
|
|
|
Service Code
|
NDC 70074056543
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna Commercial |
$53.50
|
| Rate for Payer: Anthem Medicaid |
$23.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.19
|
| Rate for Payer: Cash Price |
$34.74
|
| Rate for Payer: Cigna Commercial |
$57.67
|
| Rate for Payer: First Health Commercial |
$66.01
|
| Rate for Payer: Humana Commercial |
$59.06
|
| Rate for Payer: Humana KY Medicaid |
$23.89
|
| Rate for Payer: Kentucky WC Medicaid |
$24.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.14
|
| Rate for Payer: Ohio Health Group HMO |
$52.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.94
|
| Rate for Payer: PHCS Commercial |
$66.70
|
| Rate for Payer: United Healthcare All Payer |
$61.14
|
|
|
VITAL
|
Facility
|
IP
|
$69.48
|
|
|
Service Code
|
NDC 70074056543
|
| Hospital Charge Code |
27000103
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.84 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna Commercial |
$53.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.19
|
| Rate for Payer: Cash Price |
$34.74
|
| Rate for Payer: Cigna Commercial |
$57.67
|
| Rate for Payer: First Health Commercial |
$66.01
|
| Rate for Payer: Humana Commercial |
$59.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.14
|
| Rate for Payer: Ohio Health Group HMO |
$52.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$47.94
|
| Rate for Payer: PHCS Commercial |
$66.70
|
| Rate for Payer: United Healthcare All Payer |
$61.14
|
|
|
VITAL 1.5Cal 1,000 mL Bottle
|
Facility
|
OP
|
$98.78
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
25004381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$94.83 |
| Rate for Payer: Aetna Commercial |
$76.06
|
| Rate for Payer: Anthem Medicaid |
$33.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.05
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cigna Commercial |
$81.99
|
| Rate for Payer: First Health Commercial |
$93.84
|
| Rate for Payer: Humana Commercial |
$83.96
|
| Rate for Payer: Humana KY Medicaid |
$33.97
|
| Rate for Payer: Kentucky WC Medicaid |
$34.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$34.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.93
|
| Rate for Payer: Ohio Health Group HMO |
$74.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.16
|
| Rate for Payer: PHCS Commercial |
$94.83
|
| Rate for Payer: United Healthcare All Payer |
$86.93
|
|
|
VITAL 1.5Cal 1,000 mL Bottle
|
Facility
|
IP
|
$98.78
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
25004381
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.63 |
| Max. Negotiated Rate |
$94.83 |
| Rate for Payer: Aetna Commercial |
$76.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$77.05
|
| Rate for Payer: Cash Price |
$49.39
|
| Rate for Payer: Cigna Commercial |
$81.99
|
| Rate for Payer: First Health Commercial |
$93.84
|
| Rate for Payer: Humana Commercial |
$83.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$81.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$86.93
|
| Rate for Payer: Ohio Health Group HMO |
$74.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$79.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.16
|
| Rate for Payer: PHCS Commercial |
$94.83
|
| Rate for Payer: United Healthcare All Payer |
$86.93
|
|
|
VITAL-AF 1.2CAL 1.5L TUBEFEED
|
Facility
|
IP
|
$91.75
|
|
|
Service Code
|
NDC 70074067642
|
| Hospital Charge Code |
25003728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$70.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.56
|
| Rate for Payer: Cash Price |
$45.88
|
| Rate for Payer: Cigna Commercial |
$76.15
|
| Rate for Payer: First Health Commercial |
$87.16
|
| Rate for Payer: Humana Commercial |
$77.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.74
|
| Rate for Payer: Ohio Health Group HMO |
$68.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.31
|
| Rate for Payer: PHCS Commercial |
$88.08
|
| Rate for Payer: United Healthcare All Payer |
$80.74
|
|
|
VITAL-AF 1.2CAL 1.5L TUBEFEED
|
Facility
|
OP
|
$91.75
|
|
|
Service Code
|
NDC 70074067642
|
| Hospital Charge Code |
25003728
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$88.08 |
| Rate for Payer: Aetna Commercial |
$70.65
|
| Rate for Payer: Anthem Medicaid |
$31.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$71.56
|
| Rate for Payer: Cash Price |
$45.88
|
| Rate for Payer: Cigna Commercial |
$76.15
|
| Rate for Payer: First Health Commercial |
$87.16
|
| Rate for Payer: Humana Commercial |
$77.99
|
| Rate for Payer: Humana KY Medicaid |
$31.55
|
| Rate for Payer: Kentucky WC Medicaid |
$31.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$75.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$67.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$80.74
|
| Rate for Payer: Ohio Health Group HMO |
$68.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$73.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$79.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.31
|
| Rate for Payer: PHCS Commercial |
$88.08
|
| Rate for Payer: United Healthcare All Payer |
$80.74
|
|
|
VITALAF 1.2CAL NUTSUP TF1000ML
|
Facility
|
OP
|
$94.67
|
|
|
Service Code
|
NDC 70074062715
|
| Hospital Charge Code |
25003579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Anthem Medicaid |
$32.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.84
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: First Health Commercial |
$89.94
|
| Rate for Payer: Humana Commercial |
$80.47
|
| Rate for Payer: Humana KY Medicaid |
$32.56
|
| Rate for Payer: Kentucky WC Medicaid |
$32.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.31
|
| Rate for Payer: Ohio Health Group HMO |
$71.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.32
|
| Rate for Payer: PHCS Commercial |
$90.88
|
| Rate for Payer: United Healthcare All Payer |
$83.31
|
|
|
VITALAF 1.2CAL NUTSUP TF1000ML
|
Facility
|
IP
|
$94.67
|
|
|
Service Code
|
NDC 70074062715
|
| Hospital Charge Code |
25003579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$73.84
|
| Rate for Payer: Cash Price |
$47.34
|
| Rate for Payer: Cigna Commercial |
$78.58
|
| Rate for Payer: First Health Commercial |
$89.94
|
| Rate for Payer: Humana Commercial |
$80.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$77.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$69.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$83.31
|
| Rate for Payer: Ohio Health Group HMO |
$71.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$65.32
|
| Rate for Payer: PHCS Commercial |
$90.88
|
| Rate for Payer: United Healthcare All Payer |
$83.31
|
|
|
VITAL CAPACITY EACH PROCEDURE
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
46000004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Anthem Medicaid |
$9.08
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$31.16
|
| Rate for Payer: Healthspan PPO |
$26.62
|
| Rate for Payer: Humana Medicaid |
$9.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.26
|
| Rate for Payer: Molina Healthcare Passport |
$9.08
|
| Rate for Payer: Multiplan PHCS |
$312.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$364.00
|
| Rate for Payer: UHCCP Medicaid |
$182.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.17
|
|
|
VITAL CAPACITY EACH PROCEDURE
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
46000004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$156.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
VITAL CAPACITY EACH PROCEDURE
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
46000004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$400.40
|
| Rate for Payer: Anthem Medicaid |
$178.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$405.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cigna Commercial |
$431.60
|
| Rate for Payer: First Health Commercial |
$494.00
|
| Rate for Payer: Humana Commercial |
$442.00
|
| Rate for Payer: Humana KY Medicaid |
$178.83
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$180.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$426.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$383.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$182.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$457.60
|
| Rate for Payer: Ohio Health Group HMO |
$390.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$358.80
|
| Rate for Payer: PHCS Commercial |
$499.20
|
| Rate for Payer: United Healthcare All Payer |
$457.60
|
|
|
VITAL CAPACITY EACH PROCEDUR(P
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
460P0004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$33.83 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: Anthem Medicaid |
$9.08
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$31.16
|
| Rate for Payer: Healthspan PPO |
$26.62
|
| Rate for Payer: Humana Medicaid |
$9.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$4.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$9.26
|
| Rate for Payer: Molina Healthcare Passport |
$9.08
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$9.17
|
|
|
VITAL CAPACITY EACH PROCEDUR(T
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
460T0004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$148.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
VITAL CAPACITY EACH PROCEDUR(T
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
HCPCS 94150
|
| Hospital Charge Code |
460T0004
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna Commercial |
$381.15
|
| Rate for Payer: Anthem Medicaid |
$170.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$386.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cash Price |
$247.50
|
| Rate for Payer: Cigna Commercial |
$410.85
|
| Rate for Payer: First Health Commercial |
$470.25
|
| Rate for Payer: Humana Commercial |
$420.75
|
| Rate for Payer: Humana KY Medicaid |
$170.23
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$171.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$405.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$365.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$173.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$435.60
|
| Rate for Payer: Ohio Health Group HMO |
$371.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$341.55
|
| Rate for Payer: PHCS Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Payer |
$435.60
|
|
|
VITALITY 2 DR DC/LEAD 8456
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
VITALITY 2 DR DC/LEAD 8456
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
VITALITY 2 DR DC/LEAD 8457
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
VITALITY 2 DR DC/LEAD 8457
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
VITALITY 2 DR DC/LEAD 8458
|
Facility
|
IP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
VITALITY 2 DR DC/LEAD 8458
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
|
VITALITY 2 DR DC/LEAD 8459
|
Facility
|
OP
|
$97,900.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,370.00 |
| Max. Negotiated Rate |
$93,984.00 |
| Rate for Payer: Aetna Commercial |
$75,383.00
|
| Rate for Payer: Anthem Medicaid |
$33,667.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$76,362.00
|
| Rate for Payer: Cash Price |
$48,950.00
|
| Rate for Payer: Cigna Commercial |
$81,257.00
|
| Rate for Payer: First Health Commercial |
$93,005.00
|
| Rate for Payer: Humana Commercial |
$83,215.00
|
| Rate for Payer: Humana KY Medicaid |
$33,667.81
|
| Rate for Payer: Kentucky WC Medicaid |
$34,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$80,278.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$72,250.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29,370.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,343.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$86,152.00
|
| Rate for Payer: Ohio Health Group HMO |
$73,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$85,173.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$67,551.00
|
| Rate for Payer: PHCS Commercial |
$93,984.00
|
| Rate for Payer: United Healthcare All Payer |
$86,152.00
|
|
