|
EEG EXTEND MONITOR 41-60 MIN(T
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
740T0005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$608.64 |
| Rate for Payer: Aetna Commercial |
$488.18
|
| Rate for Payer: Anthem Medicaid |
$218.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$494.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$526.22
|
| Rate for Payer: First Health Commercial |
$602.30
|
| Rate for Payer: Humana Commercial |
$538.90
|
| Rate for Payer: Humana KY Medicaid |
$218.03
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$220.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$222.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.92
|
| Rate for Payer: Ohio Health Group HMO |
$475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.54
|
| Rate for Payer: PHCS Commercial |
$608.64
|
| Rate for Payer: United Healthcare All Payer |
$557.92
|
|
|
EEG EXTEND MONITOR 41-60 MIN(T
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
740T0005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$608.64 |
| Rate for Payer: Aetna Commercial |
$488.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$494.52
|
| Rate for Payer: Cash Price |
$317.00
|
| Rate for Payer: Cigna Commercial |
$526.22
|
| Rate for Payer: First Health Commercial |
$602.30
|
| Rate for Payer: Humana Commercial |
$538.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$519.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$467.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$557.92
|
| Rate for Payer: Ohio Health Group HMO |
$475.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$126.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$82.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$196.54
|
| Rate for Payer: PHCS Commercial |
$608.64
|
| Rate for Payer: United Healthcare All Payer |
$557.92
|
|
|
EEG - OVER 1 HOUR
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$140.92 |
| Max. Negotiated Rate |
$1,040.64 |
| Rate for Payer: Aetna Commercial |
$834.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$845.52
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cigna Commercial |
$899.72
|
| Rate for Payer: First Health Commercial |
$1,029.80
|
| Rate for Payer: Humana Commercial |
$921.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$888.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$799.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$953.92
|
| Rate for Payer: Ohio Health Group HMO |
$813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.04
|
| Rate for Payer: PHCS Commercial |
$1,040.64
|
| Rate for Payer: United Healthcare All Payer |
$953.92
|
|
|
EEG - OVER 1 HOUR
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$140.92 |
| Max. Negotiated Rate |
$1,040.64 |
| Rate for Payer: Aetna Commercial |
$834.68
|
| Rate for Payer: Anthem Medicaid |
$372.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$845.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cigna Commercial |
$899.72
|
| Rate for Payer: First Health Commercial |
$1,029.80
|
| Rate for Payer: Humana Commercial |
$921.40
|
| Rate for Payer: Humana KY Medicaid |
$372.79
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$376.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$888.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$799.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$953.92
|
| Rate for Payer: Ohio Health Group HMO |
$813.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.04
|
| Rate for Payer: PHCS Commercial |
$1,040.64
|
| Rate for Payer: United Healthcare All Payer |
$953.92
|
|
|
EEG - OVER 1 HOUR
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$103.49 |
| Max. Negotiated Rate |
$1,084.00 |
| Rate for Payer: Aetna Commercial |
$438.45
|
| Rate for Payer: Anthem Medicaid |
$304.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,084.00
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Cigna Commercial |
$411.66
|
| Rate for Payer: Healthspan PPO |
$386.18
|
| Rate for Payer: Humana Medicaid |
$304.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.88
|
| Rate for Payer: Molina Healthcare Passport |
$304.78
|
| Rate for Payer: Multiplan PHCS |
$650.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$758.80
|
| Rate for Payer: UHCCP Medicaid |
$379.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.83
|
|
|
EEG - OVER 1 HOUR(P
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
740P0006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$438.45 |
| Rate for Payer: Aetna Commercial |
$438.45
|
| Rate for Payer: Anthem Medicaid |
$304.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$411.66
|
| Rate for Payer: Healthspan PPO |
$386.18
|
| Rate for Payer: Humana Medicaid |
$304.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.49
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.88
|
| Rate for Payer: Molina Healthcare Passport |
$304.78
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.83
|
|
|
EEG - OVER 1 HOUR(T
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
740T0006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$105.82 |
| Max. Negotiated Rate |
$781.44 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: Anthem Medicaid |
$279.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna Commercial |
$675.62
|
| Rate for Payer: First Health Commercial |
$773.30
|
| Rate for Payer: Humana Commercial |
$691.90
|
| Rate for Payer: Humana KY Medicaid |
$279.93
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$282.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$667.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$600.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$285.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$716.32
|
| Rate for Payer: Ohio Health Group HMO |
$610.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.34
|
| Rate for Payer: PHCS Commercial |
$781.44
|
| Rate for Payer: United Healthcare All Payer |
$716.32
|
|
|
EEG - OVER 1 HOUR(T
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
740T0006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$105.82 |
| Max. Negotiated Rate |
$781.44 |
| Rate for Payer: Aetna Commercial |
$626.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$634.92
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna Commercial |
$675.62
|
| Rate for Payer: First Health Commercial |
$773.30
|
| Rate for Payer: Humana Commercial |
$691.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$667.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$600.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$716.32
|
| Rate for Payer: Ohio Health Group HMO |
$610.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$252.34
|
| Rate for Payer: PHCS Commercial |
$781.44
|
| Rate for Payer: United Healthcare All Payer |
$716.32
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
76102626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
761P2626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$123.80
|
| Rate for Payer: Anthem Medicaid |
$126.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Humana Medicaid |
$126.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.79
|
| Rate for Payer: Molina Healthcare Passport |
$126.26
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.00
|
| Rate for Payer: UHCCP Medicaid |
$129.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.52
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
50000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$191.44 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$123.80
|
| Rate for Payer: Anthem Medicaid |
$126.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$167.00
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Humana Medicaid |
$126.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.79
|
| Rate for Payer: Molina Healthcare Passport |
$126.26
|
| Rate for Payer: Multiplan PHCS |
$100.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$116.90
|
| Rate for Payer: UHCCP Medicaid |
$129.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.52
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
76102626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$123.80
|
| Rate for Payer: Anthem Medicaid |
$126.26
|
| Rate for Payer: Buckeye Medicare Advantage |
$360.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Humana Medicaid |
$126.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.79
|
| Rate for Payer: Molina Healthcare Passport |
$126.26
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$252.00
|
| Rate for Payer: UHCCP Medicaid |
$129.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.52
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
50000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
50000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$57.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Humana KY Medicaid |
$57.43
|
| Rate for Payer: Kentucky WC Medicaid |
$58.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
76102626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$111.60
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
EEG REPET STIM PAIRED STIMU
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
74000011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.00
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.70
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
74000011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EEG REPET STIM PAIRED STIMU
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$391.00
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$273.70
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
74000011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EEG REPET STIM PAIRED STIMU(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
922P0018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
|
|
EEG REPET STIM PAIRED STIMU(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
740P0011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
|
|
EEG REPET STIM PAIRED STIMU(T
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
740T0011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$74.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$74.28
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$75.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.96
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
|
EEG REPET STIM PAIRED STIMU(T
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
922T0018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.48
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$64.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$43.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.96
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
