|
ELECTRON PLANNING CODE(T
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
333T0012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$1,159.68 |
| Rate for Payer: Aetna Commercial |
$930.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.24
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cigna Commercial |
$1,002.64
|
| Rate for Payer: First Health Commercial |
$1,147.60
|
| Rate for Payer: Humana Commercial |
$1,026.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$990.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$891.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.04
|
| Rate for Payer: Ohio Health Group HMO |
$906.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.48
|
| Rate for Payer: PHCS Commercial |
$1,159.68
|
| Rate for Payer: United Healthcare All Payer |
$1,063.04
|
|
|
ELECTRON PLANNING CODE(T
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
333T0012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$157.04 |
| Max. Negotiated Rate |
$1,159.68 |
| Rate for Payer: Aetna Commercial |
$930.16
|
| Rate for Payer: Anthem Medicaid |
$415.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cash Price |
$604.00
|
| Rate for Payer: Cigna Commercial |
$1,002.64
|
| Rate for Payer: First Health Commercial |
$1,147.60
|
| Rate for Payer: Humana Commercial |
$1,026.80
|
| Rate for Payer: Humana KY Medicaid |
$415.43
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$419.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$990.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$891.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.04
|
| Rate for Payer: Ohio Health Group HMO |
$906.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.48
|
| Rate for Payer: PHCS Commercial |
$1,159.68
|
| Rate for Payer: United Healthcare All Payer |
$1,063.04
|
|
|
ELECTRON SETUP-C
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$260.91 |
| Max. Negotiated Rate |
$1,926.72 |
| Rate for Payer: Aetna Commercial |
$1,545.39
|
| Rate for Payer: Anthem Medicaid |
$690.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,565.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$1,665.81
|
| Rate for Payer: First Health Commercial |
$1,906.65
|
| Rate for Payer: Humana Commercial |
$1,705.95
|
| Rate for Payer: Humana KY Medicaid |
$690.21
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$697.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,645.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$704.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,766.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.17
|
| Rate for Payer: PHCS Commercial |
$1,926.72
|
| Rate for Payer: United Healthcare All Payer |
$1,766.16
|
|
|
ELECTRON SETUP-C
|
Professional
|
Both
|
$2,007.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$2,007.00 |
| Rate for Payer: Aetna Commercial |
$743.64
|
| Rate for Payer: Anthem Medicaid |
$243.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,007.00
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$582.91
|
| Rate for Payer: Healthspan PPO |
$627.13
|
| Rate for Payer: Humana Medicaid |
$243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.86
|
| Rate for Payer: Molina Healthcare Passport |
$243.00
|
| Rate for Payer: Multiplan PHCS |
$1,204.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,404.90
|
| Rate for Payer: UHCCP Medicaid |
$702.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.43
|
|
|
ELECTRON SETUP-C
|
Facility
|
IP
|
$2,007.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$260.91 |
| Max. Negotiated Rate |
$1,926.72 |
| Rate for Payer: Aetna Commercial |
$1,545.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,565.46
|
| Rate for Payer: Cash Price |
$1,003.50
|
| Rate for Payer: Cigna Commercial |
$1,665.81
|
| Rate for Payer: First Health Commercial |
$1,906.65
|
| Rate for Payer: Humana Commercial |
$1,705.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,645.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,481.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$602.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,766.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,505.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$622.17
|
| Rate for Payer: PHCS Commercial |
$1,926.72
|
| Rate for Payer: United Healthcare All Payer |
$1,766.16
|
|
|
ELECTRON SETUP-C(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
333P0003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$743.64 |
| Rate for Payer: Aetna Commercial |
$743.64
|
| Rate for Payer: Anthem Medicaid |
$243.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$400.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$582.91
|
| Rate for Payer: Healthspan PPO |
$627.13
|
| Rate for Payer: Humana Medicaid |
$243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.86
|
| Rate for Payer: Molina Healthcare Passport |
$243.00
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$280.00
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.43
|
|
|
ELECTRON SETUP-C(T
|
Facility
|
OP
|
$1,607.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
333T0003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$208.91 |
| Max. Negotiated Rate |
$1,542.72 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Anthem Medicaid |
$552.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,253.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,333.81
|
| Rate for Payer: First Health Commercial |
$1,526.65
|
| Rate for Payer: Humana Commercial |
$1,365.95
|
| Rate for Payer: Humana KY Medicaid |
$552.65
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$558.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,317.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,185.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$563.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,414.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,205.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$498.17
|
| Rate for Payer: PHCS Commercial |
$1,542.72
|
| Rate for Payer: United Healthcare All Payer |
$1,414.16
|
|
|
ELECTRON SETUP-C(T
|
Facility
|
IP
|
$1,607.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
333T0003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$208.91 |
| Max. Negotiated Rate |
$1,542.72 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,253.46
|
| Rate for Payer: Cash Price |
$803.50
|
| Rate for Payer: Cigna Commercial |
$1,333.81
|
| Rate for Payer: First Health Commercial |
$1,526.65
|
| Rate for Payer: Humana Commercial |
$1,365.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,317.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,185.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,414.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,205.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$208.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$498.17
|
| Rate for Payer: PHCS Commercial |
$1,542.72
|
| Rate for Payer: United Healthcare All Payer |
$1,414.16
|
|
|
ELECTROPHYSIOLOGY EVALUATION
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
HCPCS 93641
|
| Hospital Charge Code |
48000098
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$1,566.72 |
| Rate for Payer: Aetna Commercial |
$1,256.64
|
| Rate for Payer: Anthem Medicaid |
$561.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,272.96
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,354.56
|
| Rate for Payer: First Health Commercial |
$1,550.40
|
| Rate for Payer: Humana Commercial |
$1,387.20
|
| Rate for Payer: Humana KY Medicaid |
$561.24
|
| Rate for Payer: Kentucky WC Medicaid |
$566.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,338.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,204.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$572.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.92
|
| Rate for Payer: PHCS Commercial |
$1,566.72
|
| Rate for Payer: United Healthcare All Payer |
$1,436.16
|
|
|
ELECTROPHYSIOLOGY EVALUATION
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
HCPCS 93641
|
| Hospital Charge Code |
48000098
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$212.16 |
| Max. Negotiated Rate |
$1,566.72 |
| Rate for Payer: Aetna Commercial |
$1,256.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,272.96
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,354.56
|
| Rate for Payer: First Health Commercial |
$1,550.40
|
| Rate for Payer: Humana Commercial |
$1,387.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,338.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,204.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$326.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$212.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$505.92
|
| Rate for Payer: PHCS Commercial |
$1,566.72
|
| Rate for Payer: United Healthcare All Payer |
$1,436.16
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$388.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$232.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$271.60
|
| Rate for Payer: UHCCP Medicaid |
$135.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$404.04
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.58
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$67.34 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem Medicaid |
$178.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$404.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Humana KY Medicaid |
$178.14
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$179.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$103.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$160.58
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$50.44 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.28
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$518.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$310.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$362.60
|
| Rate for Payer: UHCCP Medicaid |
$181.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$25.74 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.38
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
ELECTRO-UROFLOWMETRY FIRST(P
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761P2071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.00
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$178.50
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
|
|
ELECTRO-UROFLOWMETRY FIRST(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761P2072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$135.73 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$125.00
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$87.50
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST(T
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761T2072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
ELEOS COLLAR 28MM 12*120
|
Facility
|
OP
|
$22,652.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,944.78 |
| Max. Negotiated Rate |
$21,746.06 |
| Rate for Payer: Aetna Commercial |
$17,442.16
|
| Rate for Payer: Anthem Medicaid |
$7,790.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,668.68
|
| Rate for Payer: Cash Price |
$11,326.08
|
| Rate for Payer: Cigna Commercial |
$18,801.28
|
| Rate for Payer: First Health Commercial |
$21,519.54
|
| Rate for Payer: Humana Commercial |
$19,254.33
|
| Rate for Payer: Humana KY Medicaid |
$7,790.07
|
| Rate for Payer: Kentucky WC Medicaid |
$7,869.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,574.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,795.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,946.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,933.89
|
| Rate for Payer: Ohio Health Group HMO |
$16,989.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,530.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,944.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,022.17
|
| Rate for Payer: PHCS Commercial |
$21,746.06
|
| Rate for Payer: United Healthcare All Payer |
$19,933.89
|
|
