|
EEG - AWAKE AND ASLEEP(T
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
740T0008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$234.90 |
| Max. Negotiated Rate |
$751.68 |
| Rate for Payer: Aetna Commercial |
$602.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.74
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$649.89
|
| Rate for Payer: First Health Commercial |
$743.85
|
| Rate for Payer: Humana Commercial |
$665.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.04
|
| Rate for Payer: Ohio Health Group HMO |
$587.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.27
|
| Rate for Payer: PHCS Commercial |
$751.68
|
| Rate for Payer: United Healthcare All Payer |
$689.04
|
|
|
EEG - AWAKE AND ASLEEP(T
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS 95819
|
| Hospital Charge Code |
740T0008
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$269.27 |
| Max. Negotiated Rate |
$751.68 |
| Rate for Payer: Aetna Commercial |
$602.91
|
| Rate for Payer: Anthem Medicaid |
$269.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$610.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$649.89
|
| Rate for Payer: First Health Commercial |
$743.85
|
| Rate for Payer: Humana Commercial |
$665.55
|
| Rate for Payer: Humana KY Medicaid |
$269.27
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$272.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$642.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$577.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$274.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$689.04
|
| Rate for Payer: Ohio Health Group HMO |
$587.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$626.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$681.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$540.27
|
| Rate for Payer: PHCS Commercial |
$751.68
|
| Rate for Payer: United Healthcare All Payer |
$689.04
|
|
|
EEG AWAKE & DROWSY
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem Medicaid |
$318.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Humana KY Medicaid |
$318.80
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$322.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
EEG AWAKE & DROWSY
|
Professional
|
Both
|
$927.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$65.64 |
| Max. Negotiated Rate |
$556.20 |
| Rate for Payer: Aetna Commercial |
$327.43
|
| Rate for Payer: Ambetter Exchange |
$345.84
|
| Rate for Payer: Anthem Medicaid |
$173.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$345.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$345.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.01
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: Healthspan PPO |
$288.40
|
| Rate for Payer: Humana Medicaid |
$173.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$345.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.52
|
| Rate for Payer: Molina Healthcare Passport |
$173.06
|
| Rate for Payer: Multiplan PHCS |
$556.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$449.59
|
| Rate for Payer: UHCCP Medicaid |
$324.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$345.84
|
|
|
EEG AWAKE & DROWSY
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
74000007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$889.92 |
| Rate for Payer: Aetna Commercial |
$713.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$723.06
|
| Rate for Payer: Cash Price |
$463.50
|
| Rate for Payer: Cigna Commercial |
$769.41
|
| Rate for Payer: First Health Commercial |
$880.65
|
| Rate for Payer: Humana Commercial |
$787.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$760.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$684.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$278.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$815.76
|
| Rate for Payer: Ohio Health Group HMO |
$695.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$806.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$639.63
|
| Rate for Payer: PHCS Commercial |
$889.92
|
| Rate for Payer: United Healthcare All Payer |
$815.76
|
|
|
EEG AWAKE & DROWSY(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
740P0007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$449.59 |
| Rate for Payer: Aetna Commercial |
$327.43
|
| Rate for Payer: Ambetter Exchange |
$345.84
|
| Rate for Payer: Anthem Medicaid |
$173.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$345.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$345.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$415.01
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$300.05
|
| Rate for Payer: Healthspan PPO |
$288.40
|
| Rate for Payer: Humana Medicaid |
$173.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.64
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$345.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$176.52
|
| Rate for Payer: Molina Healthcare Passport |
$173.06
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$449.59
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$174.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$345.84
|
|
|
EEG AWAKE & DROWSY(T
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
740T0007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$284.41 |
| Max. Negotiated Rate |
$793.92 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem Medicaid |
$284.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Humana KY Medicaid |
$284.41
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$287.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$290.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.63
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
|
EEG AWAKE & DROWSY(T
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
HCPCS 95816
|
| Hospital Charge Code |
740T0007
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$248.10 |
| Max. Negotiated Rate |
$793.92 |
| Rate for Payer: Aetna Commercial |
$636.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$645.06
|
| Rate for Payer: Cash Price |
$413.50
|
| Rate for Payer: Cigna Commercial |
$686.41
|
| Rate for Payer: First Health Commercial |
$785.65
|
| Rate for Payer: Humana Commercial |
$702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$678.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$610.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$248.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$727.76
|
| Rate for Payer: Ohio Health Group HMO |
$620.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.63
|
| Rate for Payer: PHCS Commercial |
$793.92
|
| Rate for Payer: United Healthcare All Payer |
$727.76
|
|
|
EEG CEREBRAL DEATH EVAL ONLY
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
74000010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$295.50 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
EEG CEREBRAL DEATH EVAL ONLY
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
74000010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$45.41 |
| Max. Negotiated Rate |
$689.50 |
| Rate for Payer: Aetna Commercial |
$145.45
|
| Rate for Payer: Anthem Medicaid |
$49.70
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$153.95
|
| Rate for Payer: Humana Medicaid |
$49.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.69
|
| Rate for Payer: Molina Healthcare Passport |
$49.70
|
| Rate for Payer: Multiplan PHCS |
$591.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$689.50
|
| Rate for Payer: UHCCP Medicaid |
$344.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.20
|
|
|
EEG CEREBRAL DEATH EVAL ONLY
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
74000010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$338.74 |
| Max. Negotiated Rate |
$945.60 |
| Rate for Payer: Aetna Commercial |
$758.45
|
| Rate for Payer: Anthem Medicaid |
$338.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$768.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cash Price |
$492.50
|
| Rate for Payer: Cigna Commercial |
$817.55
|
| Rate for Payer: First Health Commercial |
$935.75
|
| Rate for Payer: Humana Commercial |
$837.25
|
| Rate for Payer: Humana KY Medicaid |
$338.74
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$342.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$807.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$726.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$866.80
|
| Rate for Payer: Ohio Health Group HMO |
$738.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$788.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$856.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$679.65
|
| Rate for Payer: PHCS Commercial |
$945.60
|
| Rate for Payer: United Healthcare All Payer |
$866.80
|
|
|
EEG CEREBRAL DEATH EVAL ONLY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
740P0010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$45.41 |
| Max. Negotiated Rate |
$153.95 |
| Rate for Payer: Aetna Commercial |
$145.45
|
| Rate for Payer: Anthem Medicaid |
$49.70
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$153.95
|
| Rate for Payer: Humana Medicaid |
$49.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$45.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$50.69
|
| Rate for Payer: Molina Healthcare Passport |
$49.70
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$50.20
|
|
|
EEG CEREBRAL DEATH EVAL ONLY(T
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
740T0010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$269.96 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem Medicaid |
$269.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Humana KY Medicaid |
$269.96
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
EEG CEREBRAL DEATH EVAL ONLY(T
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
HCPCS 95824
|
| Hospital Charge Code |
740T0010
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$235.50 |
| Max. Negotiated Rate |
$753.60 |
| Rate for Payer: Aetna Commercial |
$604.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$612.30
|
| Rate for Payer: Cash Price |
$392.50
|
| Rate for Payer: Cigna Commercial |
$651.55
|
| Rate for Payer: First Health Commercial |
$745.75
|
| Rate for Payer: Humana Commercial |
$667.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$579.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.80
|
| Rate for Payer: Ohio Health Group HMO |
$588.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.65
|
| Rate for Payer: PHCS Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Payer |
$690.80
|
|
|
EEG COMA OR SLEEP ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$65.13 |
| Max. Negotiated Rate |
$510.60 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Ambetter Exchange |
$372.07
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$372.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$446.48
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$342.52
|
| Rate for Payer: Healthspan PPO |
$308.66
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$372.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$510.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.69
|
| Rate for Payer: UHCCP Medicaid |
$297.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$372.07
|
|
|
EEG COMA OR SLEEP ONLY
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$655.27
|
| Rate for Payer: Anthem Medicaid |
$292.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$706.33
|
| Rate for Payer: First Health Commercial |
$808.45
|
| Rate for Payer: Humana Commercial |
$723.35
|
| Rate for Payer: Humana KY Medicaid |
$292.66
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$295.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$298.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.88
|
| Rate for Payer: Ohio Health Group HMO |
$638.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.19
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
EEG COMA OR SLEEP ONLY
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
74000009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$255.30 |
| Max. Negotiated Rate |
$816.96 |
| Rate for Payer: Aetna Commercial |
$655.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$663.78
|
| Rate for Payer: Cash Price |
$425.50
|
| Rate for Payer: Cigna Commercial |
$706.33
|
| Rate for Payer: First Health Commercial |
$808.45
|
| Rate for Payer: Humana Commercial |
$723.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$697.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$628.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$748.88
|
| Rate for Payer: Ohio Health Group HMO |
$638.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$740.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.19
|
| Rate for Payer: PHCS Commercial |
$816.96
|
| Rate for Payer: United Healthcare All Payer |
$748.88
|
|
|
EEG COMA OR SLEEP ONLY(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
740P0009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$483.69 |
| Rate for Payer: Aetna Commercial |
$350.44
|
| Rate for Payer: Ambetter Exchange |
$372.07
|
| Rate for Payer: Anthem Medicaid |
$97.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$372.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$372.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$446.48
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$342.52
|
| Rate for Payer: Healthspan PPO |
$308.66
|
| Rate for Payer: Humana Medicaid |
$97.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.13
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$372.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$99.16
|
| Rate for Payer: Molina Healthcare Passport |
$97.22
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$483.69
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$98.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$372.07
|
|
|
EEG COMA OR SLEEP ONLY(T
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
740T0009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$251.39 |
| Max. Negotiated Rate |
$701.76 |
| Rate for Payer: Aetna Commercial |
$562.87
|
| Rate for Payer: Anthem Medicaid |
$251.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$570.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$365.50
|
| Rate for Payer: Cash Price |
$365.50
|
| Rate for Payer: Cigna Commercial |
$606.73
|
| Rate for Payer: First Health Commercial |
$694.45
|
| Rate for Payer: Humana Commercial |
$621.35
|
| Rate for Payer: Humana KY Medicaid |
$251.39
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$253.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$599.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$539.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$256.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$643.28
|
| Rate for Payer: Ohio Health Group HMO |
$548.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$504.39
|
| Rate for Payer: PHCS Commercial |
$701.76
|
| Rate for Payer: United Healthcare All Payer |
$643.28
|
|
|
EEG COMA OR SLEEP ONLY(T
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
HCPCS 95822
|
| Hospital Charge Code |
740T0009
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$219.30 |
| Max. Negotiated Rate |
$701.76 |
| Rate for Payer: Aetna Commercial |
$562.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$570.18
|
| Rate for Payer: Cash Price |
$365.50
|
| Rate for Payer: Cigna Commercial |
$606.73
|
| Rate for Payer: First Health Commercial |
$694.45
|
| Rate for Payer: Humana Commercial |
$621.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$599.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$539.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$219.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$643.28
|
| Rate for Payer: Ohio Health Group HMO |
$548.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$584.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$504.39
|
| Rate for Payer: PHCS Commercial |
$701.76
|
| Rate for Payer: United Healthcare All Payer |
$643.28
|
|
|
EEG EXTEND MONITOR 41-60 MIN
|
Facility
|
OP
|
$825.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$283.72 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem Medicaid |
$283.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Humana KY Medicaid |
$283.72
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$286.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
EEG EXTEND MONITOR 41-60 MIN
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$64.74 |
| Max. Negotiated Rate |
$495.00 |
| Rate for Payer: Aetna Commercial |
$356.50
|
| Rate for Payer: Ambetter Exchange |
$310.48
|
| Rate for Payer: Anthem Medicaid |
$84.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.58
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$322.70
|
| Rate for Payer: Healthspan PPO |
$314.01
|
| Rate for Payer: Humana Medicaid |
$84.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.66
|
| Rate for Payer: Molina Healthcare Passport |
$84.96
|
| Rate for Payer: Multiplan PHCS |
$495.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.62
|
| Rate for Payer: UHCCP Medicaid |
$288.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.48
|
|
|
EEG EXTEND MONITOR 41-60 MIN
|
Facility
|
IP
|
$825.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
74000005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$635.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$643.50
|
| Rate for Payer: Cash Price |
$412.50
|
| Rate for Payer: Cigna Commercial |
$684.75
|
| Rate for Payer: First Health Commercial |
$783.75
|
| Rate for Payer: Humana Commercial |
$701.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$676.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$726.00
|
| Rate for Payer: Ohio Health Group HMO |
$618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.25
|
| Rate for Payer: PHCS Commercial |
$792.00
|
| Rate for Payer: United Healthcare All Payer |
$726.00
|
|
|
EEG EXTEND MONITOR 41-60 MIN(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
740P0005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$403.62 |
| Rate for Payer: Aetna Commercial |
$356.50
|
| Rate for Payer: Ambetter Exchange |
$310.48
|
| Rate for Payer: Anthem Medicaid |
$84.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$310.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$310.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$372.58
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$322.70
|
| Rate for Payer: Healthspan PPO |
$314.01
|
| Rate for Payer: Humana Medicaid |
$84.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$64.74
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$310.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$310.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.66
|
| Rate for Payer: Molina Healthcare Passport |
$84.96
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$403.62
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$310.48
|
|
|
EEG EXTEND MONITOR 41-60 MIN(T
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
740T0005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$560.25
|
| Rate for Payer: First Health Commercial |
$641.25
|
| Rate for Payer: Humana Commercial |
$573.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$553.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$498.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$202.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$594.00
|
| Rate for Payer: Ohio Health Group HMO |
$506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$540.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$465.75
|
| Rate for Payer: PHCS Commercial |
$648.00
|
| Rate for Payer: United Healthcare All Payer |
$594.00
|
|
