|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
922P0010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Anthem Medicaid |
$69.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.00
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$149.08
|
| Rate for Payer: Healthspan PPO |
$85.59
|
| Rate for Payer: Humana Medicaid |
$69.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.38
|
| Rate for Payer: Molina Healthcare Passport |
$69.00
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.50
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.69
|
|
|
EMG EA EXT CONDUCTTN LIMITED
|
Facility
|
OP
|
$548.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem Medicaid |
$188.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Humana KY Medicaid |
$188.46
|
| Rate for Payer: Kentucky WC Medicaid |
$190.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.88
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
EMG EA EXT CONDUCTTN LIMITED
|
Facility
|
IP
|
$548.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$71.24 |
| Max. Negotiated Rate |
$526.08 |
| Rate for Payer: Aetna Commercial |
$421.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$427.44
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$454.84
|
| Rate for Payer: First Health Commercial |
$520.60
|
| Rate for Payer: Humana Commercial |
$465.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$449.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$404.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$164.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$482.24
|
| Rate for Payer: Ohio Health Group HMO |
$411.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$109.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.88
|
| Rate for Payer: PHCS Commercial |
$526.08
|
| Rate for Payer: United Healthcare All Payer |
$482.24
|
|
|
EMG EA EXT CONDUCTTN LIMITED
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$548.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cash Price |
$274.00
|
| Rate for Payer: Cigna Commercial |
$94.15
|
| Rate for Payer: Healthspan PPO |
$53.96
|
| Rate for Payer: Humana Medicaid |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.22
|
| Rate for Payer: Molina Healthcare Passport |
$43.35
|
| Rate for Payer: Multiplan PHCS |
$328.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$383.60
|
| Rate for Payer: UHCCP Medicaid |
$191.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.78
|
|
|
EMG EA EXT CONDUCTTN LIMITED(P
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
922P0009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$94.15
|
| Rate for Payer: Healthspan PPO |
$53.96
|
| Rate for Payer: Humana Medicaid |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.22
|
| Rate for Payer: Molina Healthcare Passport |
$43.35
|
| Rate for Payer: Multiplan PHCS |
$154.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$180.60
|
| Rate for Payer: UHCCP Medicaid |
$90.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.78
|
|
|
EMG EA EXT CONDUCTTN LIMITED(T
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
922T0009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
EMG EA EXT CONDUCTTN LIMITED(T
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
922T0009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
EMG FACIAL NERVES UNILATERAL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$370.56 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.08
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$320.38
|
| Rate for Payer: First Health Commercial |
$366.70
|
| Rate for Payer: Humana Commercial |
$328.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$316.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$339.68
|
| Rate for Payer: Ohio Health Group HMO |
$289.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.66
|
| Rate for Payer: PHCS Commercial |
$370.56
|
| Rate for Payer: United Healthcare All Payer |
$339.68
|
|
|
EMG FACIAL NERVES UNILATERAL
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Anthem Medicaid |
$132.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$320.38
|
| Rate for Payer: First Health Commercial |
$366.70
|
| Rate for Payer: Humana Commercial |
$328.10
|
| Rate for Payer: Humana KY Medicaid |
$132.75
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$134.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$316.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$339.68
|
| Rate for Payer: Ohio Health Group HMO |
$289.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.66
|
| Rate for Payer: PHCS Commercial |
$370.56
|
| Rate for Payer: United Healthcare All Payer |
$339.68
|
|
|
EMG FACIAL NERVES UNILATERAL
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$386.00 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Anthem Medicaid |
$50.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$386.00
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$102.53
|
| Rate for Payer: Healthspan PPO |
$95.47
|
| Rate for Payer: Humana Medicaid |
$50.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.70
|
| Rate for Payer: Molina Healthcare Passport |
$50.69
|
| Rate for Payer: Multiplan PHCS |
$231.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$270.20
|
| Rate for Payer: UHCCP Medicaid |
$135.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.20
|
|
|
EMG FACIAL NERVES UNILATERAL(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
922P0005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Anthem Medicaid |
$50.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$102.53
|
| Rate for Payer: Healthspan PPO |
$95.47
|
| Rate for Payer: Humana Medicaid |
$50.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.70
|
| Rate for Payer: Molina Healthcare Passport |
$50.69
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.20
|
|
|
EMG FACIAL NERVES UNILATERAL(T
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
922T0005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
EMG FACIAL NERVES UNILATERAL(T
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
922T0005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
EMG GUID CHEMONERVATION
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem Medicaid |
$26.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Humana KY Medicaid |
$26.82
|
| Rate for Payer: Kentucky WC Medicaid |
$27.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
EMG GUID CHEMONERVATION
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$74.88 |
| Rate for Payer: Aetna Commercial |
$60.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.84
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$64.74
|
| Rate for Payer: First Health Commercial |
$74.10
|
| Rate for Payer: Humana Commercial |
$66.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.64
|
| Rate for Payer: Ohio Health Group HMO |
$58.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.18
|
| Rate for Payer: PHCS Commercial |
$74.88
|
| Rate for Payer: United Healthcare All Payer |
$68.64
|
|
|
EMG GUID CHEMONERVATION
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: Anthem Medicaid |
$21.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$78.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$51.73
|
| Rate for Payer: Healthspan PPO |
$58.09
|
| Rate for Payer: Humana Medicaid |
$21.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.88
|
| Rate for Payer: Molina Healthcare Passport |
$21.45
|
| Rate for Payer: Multiplan PHCS |
$46.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.60
|
| Rate for Payer: UHCCP Medicaid |
$27.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.66
|
|
|
EMG GUID CHEMONERVATION(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
922P0008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$65.95 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: Anthem Medicaid |
$21.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$51.73
|
| Rate for Payer: Healthspan PPO |
$58.09
|
| Rate for Payer: Humana Medicaid |
$21.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.88
|
| Rate for Payer: Molina Healthcare Passport |
$21.45
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$42.00
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.66
|
|
|
EMG GUID CHEMONERVATION(T
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
922T0008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Cigna Commercial |
$14.94
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Anthem Medicaid |
$6.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.04
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Humana Commercial |
$15.30
|
| Rate for Payer: Humana KY Medicaid |
$6.19
|
| Rate for Payer: Kentucky WC Medicaid |
$6.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.84
|
| Rate for Payer: Ohio Health Group HMO |
$13.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.58
|
| Rate for Payer: PHCS Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Payer |
$15.84
|
|
|
EMG GUID CHEMONERVATION(T
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
922T0008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$17.28 |
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.04
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$14.94
|
| Rate for Payer: First Health Commercial |
$17.10
|
| Rate for Payer: Humana Commercial |
$15.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$15.84
|
| Rate for Payer: Ohio Health Group HMO |
$13.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.58
|
| Rate for Payer: PHCS Commercial |
$17.28
|
| Rate for Payer: United Healthcare All Payer |
$15.84
|
|
|
EMG LIMITED STUDY
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem Medicaid |
$89.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Humana KY Medicaid |
$89.07
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$89.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
EMG LIMITED STUDY
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: Aetna Commercial |
$67.03
|
| Rate for Payer: Anthem Medicaid |
$25.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$259.00
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$70.97
|
| Rate for Payer: Healthspan PPO |
$59.04
|
| Rate for Payer: Humana Medicaid |
$25.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.07
|
| Rate for Payer: Molina Healthcare Passport |
$25.56
|
| Rate for Payer: Multiplan PHCS |
$155.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$181.30
|
| Rate for Payer: UHCCP Medicaid |
$90.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$25.82
|
|
|
EMG LIMITED STUDY
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$80.29
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
|
EMG LIMITED STUDY(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
922P0007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$67.03
|
| Rate for Payer: Anthem Medicaid |
$25.56
|
| 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 |
$70.97
|
| Rate for Payer: Healthspan PPO |
$59.04
|
| Rate for Payer: Humana Medicaid |
$25.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$26.07
|
| Rate for Payer: Molina Healthcare Passport |
$25.56
|
| 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 |
$25.82
|
|
|
EMG LIMITED STUDY(T
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
922T0007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$133.44 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.09
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
|
EMG LIMITED STUDY(T
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
922T0007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$154.64 |
| Rate for Payer: Aetna Commercial |
$107.03
|
| Rate for Payer: Anthem Medicaid |
$47.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$108.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cash Price |
$69.50
|
| Rate for Payer: Cigna Commercial |
$115.37
|
| Rate for Payer: First Health Commercial |
$132.05
|
| Rate for Payer: Humana Commercial |
$118.15
|
| Rate for Payer: Humana KY Medicaid |
$47.80
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$48.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$102.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$122.32
|
| Rate for Payer: Ohio Health Group HMO |
$104.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$27.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$43.09
|
| Rate for Payer: PHCS Commercial |
$133.44
|
| Rate for Payer: United Healthcare All Payer |
$122.32
|
|
