|
EEG - AWAKE AND ASLEEP(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
740P0008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$350.98 |
| Rate for Payer: Aetna Commercial |
$350.98
|
| Rate for Payer: Anthem Medicaid |
$189.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$280.82
|
| Rate for Payer: Healthspan PPO |
$309.14
|
| Rate for Payer: Humana Medicaid |
$189.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.37
|
| Rate for Payer: Molina Healthcare Passport |
$189.58
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.48
|
|
|
EEG - AWAKE AND ASLEEP(T
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
740T0008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
EEG - AWAKE AND ASLEEP(T
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
740T0008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
EEG AWAKE & DROWSY
|
Facility
|
IP
|
$877.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$114.01 |
| Max. Negotiated Rate |
$841.92 |
| Rate for Payer: Aetna Commercial |
$675.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.06
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$727.91
|
| Rate for Payer: First Health Commercial |
$833.15
|
| Rate for Payer: Humana Commercial |
$745.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$263.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$771.76
|
| Rate for Payer: Ohio Health Group HMO |
$657.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.87
|
| Rate for Payer: PHCS Commercial |
$841.92
|
| Rate for Payer: United Healthcare All Payer |
$771.76
|
|
|
EEG AWAKE & DROWSY
|
Facility
|
OP
|
$877.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$114.01 |
| Max. Negotiated Rate |
$841.92 |
| Rate for Payer: Aetna Commercial |
$675.29
|
| Rate for Payer: Anthem Medicaid |
$301.60
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$684.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$727.91
|
| Rate for Payer: First Health Commercial |
$833.15
|
| Rate for Payer: Humana Commercial |
$745.45
|
| Rate for Payer: Humana KY Medicaid |
$301.60
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$304.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$719.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$647.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$307.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$771.76
|
| Rate for Payer: Ohio Health Group HMO |
$657.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$175.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$114.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$271.87
|
| Rate for Payer: PHCS Commercial |
$841.92
|
| Rate for Payer: United Healthcare All Payer |
$771.76
|
|
|
EEG AWAKE & DROWSY
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$65.64 |
| Max. Negotiated Rate |
$877.00 |
| Rate for Payer: Aetna Commercial |
$327.43
|
| Rate for Payer: Anthem Medicaid |
$173.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$877.00
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cash Price |
$438.50
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: Healthspan PPO |
$288.40
|
| Rate for Payer: Humana Medicaid |
$173.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.52
|
| Rate for Payer: Molina Healthcare Passport |
$173.06
|
| Rate for Payer: Multiplan PHCS |
$526.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$613.90
|
| Rate for Payer: UHCCP Medicaid |
$306.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.79
|
|
|
EEG AWAKE & DROWSY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
740P0007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$327.43 |
| Rate for Payer: Aetna Commercial |
$327.43
|
| Rate for Payer: Anthem Medicaid |
$173.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: Healthspan PPO |
$288.40
|
| Rate for Payer: Humana Medicaid |
$173.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.52
|
| Rate for Payer: Molina Healthcare Passport |
$173.06
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.79
|
|
|
EEG AWAKE & DROWSY(T
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
740T0007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$233.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
EEG AWAKE & DROWSY(T
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
740T0007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$745.92 |
| Rate for Payer: Aetna Commercial |
$598.29
|
| Rate for Payer: Anthem Medicaid |
$267.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$606.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cash Price |
$388.50
|
| Rate for Payer: Cigna Commercial |
$644.91
|
| Rate for Payer: First Health Commercial |
$738.15
|
| Rate for Payer: Humana Commercial |
$660.45
|
| Rate for Payer: Humana KY Medicaid |
$267.21
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$269.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$637.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$573.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$683.76
|
| Rate for Payer: Ohio Health Group HMO |
$582.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.87
|
| Rate for Payer: PHCS Commercial |
$745.92
|
| Rate for Payer: United Healthcare All Payer |
$683.76
|
|
|
EEG CEREBRAL DEATH EVAL ONLY
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
74000010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$919.68 |
| Rate for Payer: Aetna Commercial |
$737.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$747.24
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cigna Commercial |
$795.14
|
| Rate for Payer: First Health Commercial |
$910.10
|
| Rate for Payer: Humana Commercial |
$814.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$785.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.04
|
| Rate for Payer: Ohio Health Group HMO |
$718.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.98
|
| Rate for Payer: PHCS Commercial |
$919.68
|
| Rate for Payer: United Healthcare All Payer |
$843.04
|
|
|
EEG CEREBRAL DEATH EVAL ONLY
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
74000010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$45.41 |
| Max. Negotiated Rate |
$958.00 |
| Rate for Payer: Aetna Commercial |
$145.45
|
| Rate for Payer: Anthem Medicaid |
$49.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$958.00
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cigna Commercial |
$153.95
|
| Rate for Payer: Humana Medicaid |
$49.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.69
|
| Rate for Payer: Molina Healthcare Passport |
$49.70
|
| Rate for Payer: Multiplan PHCS |
$574.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$670.60
|
| Rate for Payer: UHCCP Medicaid |
$335.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.20
|
|
|
EEG CEREBRAL DEATH EVAL ONLY
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
74000010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$919.68 |
| Rate for Payer: Aetna Commercial |
$737.66
|
| Rate for Payer: Anthem Medicaid |
$329.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$747.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cash Price |
$479.00
|
| Rate for Payer: Cigna Commercial |
$795.14
|
| Rate for Payer: First Health Commercial |
$910.10
|
| Rate for Payer: Humana Commercial |
$814.30
|
| Rate for Payer: Humana KY Medicaid |
$329.46
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$332.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$785.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$707.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$336.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$843.04
|
| Rate for Payer: Ohio Health Group HMO |
$718.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$191.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.98
|
| Rate for Payer: PHCS Commercial |
$919.68
|
| Rate for Payer: United Healthcare All Payer |
$843.04
|
|
|
EEG CEREBRAL DEATH EVAL ONLY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
740P0010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$45.41 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$145.45
|
| Rate for Payer: Anthem Medicaid |
$49.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$153.95
|
| Rate for Payer: Humana Medicaid |
$49.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.69
|
| Rate for Payer: Molina Healthcare Passport |
$49.70
|
| 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 |
$50.20
|
|
|
EEG CEREBRAL DEATH EVAL ONLY(T
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
740T0010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.98
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
EEG CEREBRAL DEATH EVAL ONLY(T
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
740T0010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$98.54 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$583.66
|
| Rate for Payer: Anthem Medicaid |
$260.68
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$591.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cash Price |
$379.00
|
| Rate for Payer: Cigna Commercial |
$629.14
|
| Rate for Payer: First Health Commercial |
$720.10
|
| Rate for Payer: Humana Commercial |
$644.30
|
| Rate for Payer: Humana KY Medicaid |
$260.68
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$263.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$667.04
|
| Rate for Payer: Ohio Health Group HMO |
$568.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.98
|
| Rate for Payer: PHCS Commercial |
$727.68
|
| Rate for Payer: United Healthcare All Payer |
$667.04
|
|
|
EEG COMA OR SLEEP ONLY
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$773.76 |
| Rate for Payer: Aetna Commercial |
$620.62
|
| Rate for Payer: Anthem Medicaid |
$277.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$628.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Cigna Commercial |
$668.98
|
| Rate for Payer: First Health Commercial |
$765.70
|
| Rate for Payer: Humana Commercial |
$685.10
|
| Rate for Payer: Humana KY Medicaid |
$277.18
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$280.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$709.28
|
| Rate for Payer: Ohio Health Group HMO |
$604.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.86
|
| Rate for Payer: PHCS Commercial |
$773.76
|
| Rate for Payer: United Healthcare All Payer |
$709.28
|
|
|
EEG COMA OR SLEEP ONLY
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$806.00 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$806.00
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Cigna Commercial |
$342.52
|
| Rate for Payer: Healthspan PPO |
$308.66
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$483.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$564.20
|
| Rate for Payer: UHCCP Medicaid |
$282.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
|
|
EEG COMA OR SLEEP ONLY
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$104.78 |
| Max. Negotiated Rate |
$773.76 |
| Rate for Payer: Aetna Commercial |
$620.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$628.68
|
| Rate for Payer: Cash Price |
$403.00
|
| Rate for Payer: Cigna Commercial |
$668.98
|
| Rate for Payer: First Health Commercial |
$765.70
|
| Rate for Payer: Humana Commercial |
$685.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$709.28
|
| Rate for Payer: Ohio Health Group HMO |
$604.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$249.86
|
| Rate for Payer: PHCS Commercial |
$773.76
|
| Rate for Payer: United Healthcare All Payer |
$709.28
|
|
|
EEG COMA OR SLEEP ONLY(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
740P0009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$350.44 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$120.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$342.52
|
| Rate for Payer: Healthspan PPO |
$308.66
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.13
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$84.00
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
|
|
EEG COMA OR SLEEP ONLY(T
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
740T0009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$205.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.66
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
EEG COMA OR SLEEP ONLY(T
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
740T0009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$658.56 |
| Rate for Payer: Aetna Commercial |
$528.22
|
| Rate for Payer: Anthem Medicaid |
$235.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$535.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cash Price |
$343.00
|
| Rate for Payer: Cigna Commercial |
$569.38
|
| Rate for Payer: First Health Commercial |
$651.70
|
| Rate for Payer: Humana Commercial |
$583.10
|
| Rate for Payer: Humana KY Medicaid |
$235.92
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$238.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$562.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$506.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$240.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$603.68
|
| Rate for Payer: Ohio Health Group HMO |
$514.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$137.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$89.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$212.66
|
| Rate for Payer: PHCS Commercial |
$658.56
|
| Rate for Payer: United Healthcare All Payer |
$603.68
|
|
|
EEG EXTEND MONITOR 41-60 MIN
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$356.50
|
| Rate for Payer: Anthem Medicaid |
$84.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$784.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$322.70
|
| Rate for Payer: Healthspan PPO |
$314.01
|
| Rate for Payer: Humana Medicaid |
$84.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.66
|
| Rate for Payer: Molina Healthcare Passport |
$84.96
|
| Rate for Payer: Multiplan PHCS |
$470.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$548.80
|
| Rate for Payer: UHCCP Medicaid |
$274.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.81
|
|
|
EEG EXTEND MONITOR 41-60 MIN
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.52
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.04
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
EEG EXTEND MONITOR 41-60 MIN
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$752.64 |
| Rate for Payer: Aetna Commercial |
$603.68
|
| Rate for Payer: Anthem Medicaid |
$269.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cigna Commercial |
$650.72
|
| Rate for Payer: First Health Commercial |
$744.80
|
| Rate for Payer: Humana Commercial |
$666.40
|
| Rate for Payer: Humana KY Medicaid |
$269.62
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$272.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.92
|
| Rate for Payer: Ohio Health Group HMO |
$588.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.04
|
| Rate for Payer: PHCS Commercial |
$752.64
|
| Rate for Payer: United Healthcare All Payer |
$689.92
|
|
|
EEG EXTEND MONITOR 41-60 MIN(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
740P0005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$356.50 |
| Rate for Payer: Aetna Commercial |
$356.50
|
| Rate for Payer: Anthem Medicaid |
$84.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$322.70
|
| Rate for Payer: Healthspan PPO |
$314.01
|
| Rate for Payer: Humana Medicaid |
$84.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.66
|
| Rate for Payer: Molina Healthcare Passport |
$84.96
|
| 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
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.81
|
|
