|
ADV TIBIA BASE WO HOLE SZ4+
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
ADV TIBIA BASE WO HOLE SZ5+
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
ADV TIBIA BASE WO HOLE SZ5+
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
AEP HEARING STATUS DETER I&R
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
470P0071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$94.74 |
| Rate for Payer: Ambetter Exchange |
$72.88
|
| Rate for Payer: Anthem Medicaid |
$71.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.46
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Humana Medicaid |
$71.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.42
|
| Rate for Payer: Molina Healthcare Passport |
$71.00
|
| Rate for Payer: Multiplan PHCS |
$48.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.74
|
| Rate for Payer: UHCCP Medicaid |
$28.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.88
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
47000071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem Medicaid |
$47.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Humana KY Medicaid |
$47.80
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$48.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.91
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
470T0071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem Medicaid |
$19.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Humana KY Medicaid |
$19.95
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$20.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$20.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
47000071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$111.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.91
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
AEP HEARING STATUS DETER I&R
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
47000071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$94.74 |
| Rate for Payer: Ambetter Exchange |
$72.88
|
| Rate for Payer: Anthem Medicaid |
$71.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$87.46
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Humana Medicaid |
$71.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$72.42
|
| Rate for Payer: Molina Healthcare Passport |
$71.00
|
| Rate for Payer: Multiplan PHCS |
$83.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.74
|
| Rate for Payer: UHCCP Medicaid |
$48.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.71
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.88
|
|
|
AEP HEARING STATUS DETER I&R
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
HCPCS 92651
|
| Hospital Charge Code |
470T0071
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$55.68 |
| Rate for Payer: Aetna Commercial |
$44.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$45.24
|
| Rate for Payer: Cash Price |
$29.00
|
| Rate for Payer: Cigna Commercial |
$48.14
|
| Rate for Payer: First Health Commercial |
$55.10
|
| Rate for Payer: Humana Commercial |
$49.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$47.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$42.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$51.04
|
| Rate for Payer: Ohio Health Group HMO |
$43.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$40.02
|
| Rate for Payer: PHCS Commercial |
$55.68
|
| Rate for Payer: United Healthcare All Payer |
$51.04
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
47000073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$69.32 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Ambetter Exchange |
$74.83
|
| Rate for Payer: Anthem Medicaid |
$69.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.80
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Humana Medicaid |
$69.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.71
|
| Rate for Payer: Molina Healthcare Passport |
$69.32
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.28
|
| Rate for Payer: UHCCP Medicaid |
$92.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.83
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
470T0073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$150.72 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.46
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.33
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
47000073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$254.40 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$206.70
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$219.95
|
| Rate for Payer: First Health Commercial |
$251.75
|
| Rate for Payer: Humana Commercial |
$225.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$217.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$195.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$79.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$233.20
|
| Rate for Payer: Ohio Health Group HMO |
$198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.85
|
| Rate for Payer: PHCS Commercial |
$254.40
|
| Rate for Payer: United Healthcare All Payer |
$233.20
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
470T0073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$53.99 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Anthem Medicaid |
$53.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cash Price |
$78.50
|
| Rate for Payer: Cigna Commercial |
$130.31
|
| Rate for Payer: First Health Commercial |
$149.15
|
| Rate for Payer: Humana Commercial |
$133.45
|
| Rate for Payer: Humana KY Medicaid |
$53.99
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$54.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$138.16
|
| Rate for Payer: Ohio Health Group HMO |
$117.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.33
|
| Rate for Payer: PHCS Commercial |
$150.72
|
| Rate for Payer: United Healthcare All Payer |
$138.16
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
47000073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$91.13 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Anthem Medicaid |
$91.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$206.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$219.95
|
| Rate for Payer: First Health Commercial |
$251.75
|
| Rate for Payer: Humana Commercial |
$225.25
|
| Rate for Payer: Humana KY Medicaid |
$91.13
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$92.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$217.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$195.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$233.20
|
| Rate for Payer: Ohio Health Group HMO |
$198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$212.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$182.85
|
| Rate for Payer: PHCS Commercial |
$254.40
|
| Rate for Payer: United Healthcare All Payer |
$233.20
|
|
|
AEP NEURODIAGNOSTIC I&R
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 92653
|
| Hospital Charge Code |
470P0073
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$97.28 |
| Rate for Payer: Ambetter Exchange |
$74.83
|
| Rate for Payer: Anthem Medicaid |
$69.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$74.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$74.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$89.80
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Humana Medicaid |
$69.32
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$74.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.83
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.71
|
| Rate for Payer: Molina Healthcare Passport |
$69.32
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.28
|
| Rate for Payer: UHCCP Medicaid |
$37.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$70.01
|
| Rate for Payer: Wellcare Medicare Advantage |
$74.83
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
47000072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$94.37 |
| Max. Negotiated Rate |
$164.40 |
| Rate for Payer: Ambetter Exchange |
$100.36
|
| Rate for Payer: Anthem Medicaid |
$94.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.43
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Humana Medicaid |
$94.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.26
|
| Rate for Payer: Molina Healthcare Passport |
$94.37
|
| Rate for Payer: Multiplan PHCS |
$164.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.47
|
| Rate for Payer: UHCCP Medicaid |
$95.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.36
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
470T0072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.70
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
470T0072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$127.05
|
| Rate for Payer: Anthem Medicaid |
$56.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$136.95
|
| Rate for Payer: First Health Commercial |
$156.75
|
| Rate for Payer: Humana Commercial |
$140.25
|
| Rate for Payer: Humana KY Medicaid |
$56.74
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$57.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$145.20
|
| Rate for Payer: Ohio Health Group HMO |
$123.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$143.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$113.85
|
| Rate for Payer: PHCS Commercial |
$158.40
|
| Rate for Payer: United Healthcare All Payer |
$145.20
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
470P0072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$130.47 |
| Rate for Payer: Ambetter Exchange |
$100.36
|
| Rate for Payer: Anthem Medicaid |
$94.37
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.43
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Humana Medicaid |
$94.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.26
|
| Rate for Payer: Molina Healthcare Passport |
$94.37
|
| Rate for Payer: Multiplan PHCS |
$64.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.47
|
| Rate for Payer: UHCCP Medicaid |
$37.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.36
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
47000072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$94.23 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem Medicaid |
$94.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Humana KY Medicaid |
$94.23
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$95.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.06
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
AEP THRSHLD EST MLT FREQ I&R
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
HCPCS 92652
|
| Hospital Charge Code |
47000072
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$263.04 |
| Rate for Payer: Aetna Commercial |
$210.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.72
|
| Rate for Payer: Cash Price |
$137.00
|
| Rate for Payer: Cigna Commercial |
$227.42
|
| Rate for Payer: First Health Commercial |
$260.30
|
| Rate for Payer: Humana Commercial |
$232.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$241.12
|
| Rate for Payer: Ohio Health Group HMO |
$205.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$189.06
|
| Rate for Payer: PHCS Commercial |
$263.04
|
| Rate for Payer: United Healthcare All Payer |
$241.12
|
|
|
AEROBIC CULTURE
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem Medicaid |
$9.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.89
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Humana KY Medicaid |
$9.89
|
| Rate for Payer: Humana Medicare Advantage |
$9.89
|
| Rate for Payer: Kentucky WC Medicaid |
$9.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
AEROBIC CULTURE
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$111.36 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.15
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$96.28
|
| Rate for Payer: First Health Commercial |
$110.20
|
| Rate for Payer: Humana Commercial |
$98.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$95.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$85.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$102.08
|
| Rate for Payer: Ohio Health Group HMO |
$87.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.04
|
| Rate for Payer: PHCS Commercial |
$111.36
|
| Rate for Payer: United Healthcare All Payer |
$102.08
|
|
|
AEROBIC CULTURE
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 87071
|
| Hospital Charge Code |
30001253
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: Aetna Commercial |
$8.16
|
| Rate for Payer: Ambetter Exchange |
$9.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$9.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$9.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$11.87
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cash Price |
$58.00
|
| Rate for Payer: Cigna Commercial |
$8.38
|
| Rate for Payer: Healthspan PPO |
$4.94
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$9.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.89
|
| Rate for Payer: Multiplan PHCS |
$69.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$12.86
|
| Rate for Payer: UHCCP Medicaid |
$40.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$5.93
|
| Rate for Payer: Wellcare Medicare Advantage |
$9.89
|
|
|
AERO DV TRACHBRONCH STENT 12*2
|
Facility
|
IP
|
$11,574.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
27000125
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,472.20 |
| Max. Negotiated Rate |
$11,111.04 |
| Rate for Payer: Aetna Commercial |
$8,911.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,027.72
|
| Rate for Payer: Cash Price |
$5,787.00
|
| Rate for Payer: Cigna Commercial |
$9,606.42
|
| Rate for Payer: First Health Commercial |
$10,995.30
|
| Rate for Payer: Humana Commercial |
$9,837.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,490.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,541.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,472.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,185.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,680.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,259.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,069.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,986.06
|
| Rate for Payer: PHCS Commercial |
$11,111.04
|
| Rate for Payer: United Healthcare All Payer |
$10,185.12
|
|
