|
EEG EXTEND MONITOR 41-60 MIN(T
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS 95812
|
| Hospital Charge Code |
740T0005
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$232.13 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$519.75
|
| Rate for Payer: Anthem Medicaid |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$526.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$337.50
|
| 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: Humana KY Medicaid |
$232.13
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$234.50
|
| 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 |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$236.79
|
| 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
|
|
|
EEG - OVER 1 HOUR
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$340.80 |
| Max. Negotiated Rate |
$1,090.56 |
| Rate for Payer: Aetna Commercial |
$874.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.08
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna Commercial |
$942.88
|
| Rate for Payer: First Health Commercial |
$1,079.20
|
| Rate for Payer: Humana Commercial |
$965.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$999.68
|
| Rate for Payer: Ohio Health Group HMO |
$852.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$908.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.84
|
| Rate for Payer: PHCS Commercial |
$1,090.56
|
| Rate for Payer: United Healthcare All Payer |
$999.68
|
|
|
EEG - OVER 1 HOUR
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$103.49 |
| Max. Negotiated Rate |
$681.60 |
| Rate for Payer: Aetna Commercial |
$438.45
|
| Rate for Payer: Ambetter Exchange |
$396.71
|
| Rate for Payer: Anthem Medicaid |
$304.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$396.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$396.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$476.05
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna Commercial |
$411.66
|
| Rate for Payer: Healthspan PPO |
$386.18
|
| Rate for Payer: Humana Medicaid |
$304.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$396.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.88
|
| Rate for Payer: Molina Healthcare Passport |
$304.78
|
| Rate for Payer: Multiplan PHCS |
$681.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$515.72
|
| Rate for Payer: UHCCP Medicaid |
$397.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$396.71
|
|
|
EEG - OVER 1 HOUR
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
74000006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,090.56 |
| Rate for Payer: Aetna Commercial |
$874.72
|
| Rate for Payer: Anthem Medicaid |
$390.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cigna Commercial |
$942.88
|
| Rate for Payer: First Health Commercial |
$1,079.20
|
| Rate for Payer: Humana Commercial |
$965.60
|
| Rate for Payer: Humana KY Medicaid |
$390.67
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$394.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$999.68
|
| Rate for Payer: Ohio Health Group HMO |
$852.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$908.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$988.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$783.84
|
| Rate for Payer: PHCS Commercial |
$1,090.56
|
| Rate for Payer: United Healthcare All Payer |
$999.68
|
|
|
EEG - OVER 1 HOUR(P
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
740P0006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$515.72 |
| Rate for Payer: Aetna Commercial |
$438.45
|
| Rate for Payer: Ambetter Exchange |
$396.71
|
| Rate for Payer: Anthem Medicaid |
$304.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$396.71
|
| Rate for Payer: Buckeye Medicare Advantage |
$396.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$476.05
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$411.66
|
| Rate for Payer: Healthspan PPO |
$386.18
|
| Rate for Payer: Humana Medicaid |
$304.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$103.49
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$396.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$310.88
|
| Rate for Payer: Molina Healthcare Passport |
$304.78
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$515.72
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$307.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$396.71
|
|
|
EEG - OVER 1 HOUR(T
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
740T0006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$259.80 |
| Max. Negotiated Rate |
$831.36 |
| Rate for Payer: Aetna Commercial |
$666.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$675.48
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cigna Commercial |
$718.78
|
| Rate for Payer: First Health Commercial |
$822.70
|
| Rate for Payer: Humana Commercial |
$736.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$710.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$639.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$762.08
|
| Rate for Payer: Ohio Health Group HMO |
$649.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$753.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.54
|
| Rate for Payer: PHCS Commercial |
$831.36
|
| Rate for Payer: United Healthcare All Payer |
$762.08
|
|
|
EEG - OVER 1 HOUR(T
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
HCPCS 95813
|
| Hospital Charge Code |
740T0006
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$831.36 |
| Rate for Payer: Aetna Commercial |
$666.82
|
| Rate for Payer: Anthem Medicaid |
$297.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$675.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cash Price |
$433.00
|
| Rate for Payer: Cigna Commercial |
$718.78
|
| Rate for Payer: First Health Commercial |
$822.70
|
| Rate for Payer: Humana Commercial |
$736.10
|
| Rate for Payer: Humana KY Medicaid |
$297.82
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$300.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$710.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$639.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$762.08
|
| Rate for Payer: Ohio Health Group HMO |
$649.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$753.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.54
|
| Rate for Payer: PHCS Commercial |
$831.36
|
| Rate for Payer: United Healthcare All Payer |
$762.08
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
761P2626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Ambetter Exchange |
$149.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$123.80
|
| Rate for Payer: Anthem Medicaid |
$127.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.47
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Humana Medicaid |
$127.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.10
|
| Rate for Payer: Molina Healthcare Passport |
$127.55
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$129.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.56
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
50000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.20 |
| Max. Negotiated Rate |
$194.43 |
| Rate for Payer: Ambetter Exchange |
$149.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$123.80
|
| Rate for Payer: Anthem Medicaid |
$127.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.47
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Humana Medicaid |
$127.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.10
|
| Rate for Payer: Molina Healthcare Passport |
$127.55
|
| Rate for Payer: Multiplan PHCS |
$100.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$129.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.56
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
50000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$57.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Humana KY Medicaid |
$57.43
|
| Rate for Payer: Kentucky WC Medicaid |
$58.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.23
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
76102626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Ambetter Exchange |
$149.56
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$123.80
|
| Rate for Payer: Anthem Medicaid |
$127.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$149.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$149.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$179.47
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Humana Medicaid |
$127.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$191.44
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$149.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$149.56
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$130.10
|
| Rate for Payer: Molina Healthcare Passport |
$127.55
|
| Rate for Payer: Multiplan PHCS |
$216.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$194.43
|
| Rate for Payer: UHCCP Medicaid |
$129.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$128.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$149.56
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
50000201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$130.26
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.23
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
76102626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
EEG PHYS/QHP EA INCR W/O VID
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS 95719
|
| Hospital Charge Code |
76102626
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$345.60 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Anthem Medicaid |
$123.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$298.80
|
| Rate for Payer: First Health Commercial |
$342.00
|
| Rate for Payer: Humana Commercial |
$306.00
|
| Rate for Payer: Humana KY Medicaid |
$123.80
|
| Rate for Payer: Kentucky WC Medicaid |
$125.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$295.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.80
|
| Rate for Payer: Ohio Health Group HMO |
$270.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.40
|
| Rate for Payer: PHCS Commercial |
$345.60
|
| Rate for Payer: United Healthcare All Payer |
$316.80
|
|
|
EEG REPET STIM PAIRED STIMU
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Ambetter Exchange |
$91.61
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.93
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$234.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.09
|
| Rate for Payer: UHCCP Medicaid |
$136.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.61
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
74000011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.45
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
92200018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$340.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$269.79
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EEG REPET STIM PAIRED STIMU
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
74000011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Ambetter Exchange |
$91.61
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.93
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.09
|
| Rate for Payer: UHCCP Medicaid |
$141.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.61
|
|
|
EEG REPET STIM PAIRED STIMU
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
74000011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$139.28 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Aetna Commercial |
$311.85
|
| Rate for Payer: Anthem Medicaid |
$139.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$315.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$336.15
|
| Rate for Payer: First Health Commercial |
$384.75
|
| Rate for Payer: Humana Commercial |
$344.25
|
| Rate for Payer: Humana KY Medicaid |
$139.28
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$140.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$332.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$298.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$142.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$356.40
|
| Rate for Payer: Ohio Health Group HMO |
$303.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$324.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$352.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$279.45
|
| Rate for Payer: PHCS Commercial |
$388.80
|
| Rate for Payer: United Healthcare All Payer |
$356.40
|
|
|
EEG REPET STIM PAIRED STIMU(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
740P0011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$119.09 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Ambetter Exchange |
$91.61
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.93
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.09
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.61
|
|
|
EEG REPET STIM PAIRED STIMU(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
922P0018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$119.09 |
| Rate for Payer: Aetna Commercial |
$88.53
|
| Rate for Payer: Ambetter Exchange |
$91.61
|
| Rate for Payer: Anthem Medicaid |
$39.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.93
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$79.44
|
| Rate for Payer: Healthspan PPO |
$77.97
|
| Rate for Payer: Humana Medicaid |
$39.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.05
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.76
|
| Rate for Payer: Molina Healthcare Passport |
$39.96
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$119.09
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.36
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.61
|
|
|
EEG REPET STIM PAIRED STIMU(T
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
740T0011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem Medicaid |
$79.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Humana KY Medicaid |
$79.10
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$79.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
EEG REPET STIM PAIRED STIMU(T
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
740T0011
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$177.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$179.40
|
| Rate for Payer: Cash Price |
$115.00
|
| Rate for Payer: Cigna Commercial |
$190.90
|
| Rate for Payer: First Health Commercial |
$218.50
|
| Rate for Payer: Humana Commercial |
$195.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$188.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$202.40
|
| Rate for Payer: Ohio Health Group HMO |
$172.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.70
|
| Rate for Payer: PHCS Commercial |
$220.80
|
| Rate for Payer: United Healthcare All Payer |
$202.40
|
|
|
EEG REPET STIM PAIRED STIMU(T
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 95937
|
| Hospital Charge Code |
922T0018
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$74.28 |
| Max. Negotiated Rate |
$207.36 |
| Rate for Payer: Aetna Commercial |
$166.32
|
| Rate for Payer: Anthem Medicaid |
$74.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$168.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$179.28
|
| Rate for Payer: First Health Commercial |
$205.20
|
| Rate for Payer: Humana Commercial |
$183.60
|
| Rate for Payer: Humana KY Medicaid |
$74.28
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$75.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$177.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$159.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$75.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$190.08
|
| Rate for Payer: Ohio Health Group HMO |
$162.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$172.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$187.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$149.04
|
| Rate for Payer: PHCS Commercial |
$207.36
|
| Rate for Payer: United Healthcare All Payer |
$190.08
|
|
