|
EVAL PRESC SPEECH DEV 1ST HR
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 92607
|
| Hospital Charge Code |
44000010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$31.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$75.95
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EVAL PRESC SPEECH DEV 1ST HR
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 92607
|
| Hospital Charge Code |
44000010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$224.07
|
| Rate for Payer: Anthem Medicaid |
$76.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$245.00
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$194.15
|
| Rate for Payer: Healthspan PPO |
$183.36
|
| Rate for Payer: Humana Medicaid |
$76.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$203.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.85
|
| Rate for Payer: Molina Healthcare Passport |
$76.32
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$171.50
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.08
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
41000081
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$258.22 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
92000011
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
76102496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.69
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
41000081
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
76102496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$38.87 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$230.23
|
| Rate for Payer: Anthem Medicaid |
$102.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$248.17
|
| Rate for Payer: First Health Commercial |
$284.05
|
| Rate for Payer: Humana Commercial |
$254.15
|
| Rate for Payer: Humana KY Medicaid |
$102.83
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$103.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$220.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.12
|
| Rate for Payer: Ohio Health Group HMO |
$224.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.69
|
| Rate for Payer: PHCS Commercial |
$287.04
|
| Rate for Payer: United Healthcare All Payer |
$263.12
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
92000011
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$258.22 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATE PT USE OF INHALER
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
76102496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: Anthem Medicaid |
$12.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$299.00
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cigna Commercial |
$20.47
|
| Rate for Payer: Healthspan PPO |
$17.55
|
| Rate for Payer: Humana Medicaid |
$12.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.90
|
| Rate for Payer: Molina Healthcare Passport |
$12.65
|
| Rate for Payer: Multiplan PHCS |
$179.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$209.30
|
| Rate for Payer: UHCCP Medicaid |
$104.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.78
|
|
|
EVALUATE PT USE OF INHALER(P
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
761P2496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: Anthem Medicaid |
$12.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$25.00
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cigna Commercial |
$20.47
|
| Rate for Payer: Healthspan PPO |
$17.55
|
| Rate for Payer: Humana Medicaid |
$12.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.26
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.90
|
| Rate for Payer: Molina Healthcare Passport |
$12.65
|
| Rate for Payer: Multiplan PHCS |
$15.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.50
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.78
|
|
|
EVALUATE PT USE OF INHALER(T
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
761T2496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$258.22 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$184.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$258.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$248.99
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Humana KY Medicaid |
$90.45
|
| Rate for Payer: Humana Medicare Advantage |
$184.44
|
| Rate for Payer: Kentucky WC Medicaid |
$91.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$221.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$92.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATE PT USE OF INHALER(T
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
761T2496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$34.19 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Cash Price |
$131.50
|
| Rate for Payer: Cigna Commercial |
$218.29
|
| Rate for Payer: First Health Commercial |
$249.85
|
| Rate for Payer: Humana Commercial |
$223.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$215.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$194.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$78.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$231.44
|
| Rate for Payer: Ohio Health Group HMO |
$197.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$81.53
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATION OF SWALLOWING
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
44000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem Medicaid |
$85.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.22
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Humana KY Medicaid |
$85.63
|
| Rate for Payer: Kentucky WC Medicaid |
$86.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.19
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
|
EVALUATION OF SWALLOWING
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
HCPCS 92610
|
| Hospital Charge Code |
44000013
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$239.04 |
| Rate for Payer: Aetna Commercial |
$191.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$194.22
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: First Health Commercial |
$236.55
|
| Rate for Payer: Humana Commercial |
$211.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$204.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$219.12
|
| Rate for Payer: Ohio Health Group HMO |
$186.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.19
|
| Rate for Payer: PHCS Commercial |
$239.04
|
| Rate for Payer: United Healthcare All Payer |
$219.12
|
|
|
EVASC RPR A-AO NDGFT
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS 34701
|
| Hospital Charge Code |
76101345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$1,204.80 |
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Anthem Medicaid |
$431.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$978.90
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,041.65
|
| Rate for Payer: First Health Commercial |
$1,192.25
|
| Rate for Payer: Humana Commercial |
$1,066.75
|
| Rate for Payer: Humana KY Medicaid |
$431.59
|
| Rate for Payer: Kentucky WC Medicaid |
$435.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$440.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,104.40
|
| Rate for Payer: Ohio Health Group HMO |
$941.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.05
|
| Rate for Payer: PHCS Commercial |
$1,204.80
|
| Rate for Payer: United Healthcare All Payer |
$1,104.40
|
|
|
EVASC RPR A-AO NDGFT
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS 34701
|
| Hospital Charge Code |
76101345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.15 |
| Max. Negotiated Rate |
$1,204.80 |
| Rate for Payer: Aetna Commercial |
$966.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$978.90
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$1,041.65
|
| Rate for Payer: First Health Commercial |
$1,192.25
|
| Rate for Payer: Humana Commercial |
$1,066.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,029.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$926.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$376.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,104.40
|
| Rate for Payer: Ohio Health Group HMO |
$941.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$251.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.05
|
| Rate for Payer: PHCS Commercial |
$1,204.80
|
| Rate for Payer: United Healthcare All Payer |
$1,104.40
|
|
|
EVASC RPR A-AO NDGFT
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 34701
|
| Hospital Charge Code |
76101345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.25 |
| Max. Negotiated Rate |
$2,263.79 |
| Rate for Payer: Anthem Medicaid |
$989.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,255.00
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$2,263.79
|
| Rate for Payer: Humana Medicaid |
$989.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,651.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,009.68
|
| Rate for Payer: Molina Healthcare Passport |
$989.88
|
| Rate for Payer: Multiplan PHCS |
$753.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$878.50
|
| Rate for Payer: UHCCP Medicaid |
$439.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$999.78
|
|
|
EVASC RPR A-AO NDGFT(P
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 34701
|
| Hospital Charge Code |
761P1345
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$439.25 |
| Max. Negotiated Rate |
$2,263.79 |
| Rate for Payer: Anthem Medicaid |
$989.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,255.00
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cash Price |
$627.50
|
| Rate for Payer: Cigna Commercial |
$2,263.79
|
| Rate for Payer: Humana Medicaid |
$989.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,651.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,009.68
|
| Rate for Payer: Molina Healthcare Passport |
$989.88
|
| Rate for Payer: Multiplan PHCS |
$753.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$878.50
|
| Rate for Payer: UHCCP Medicaid |
$439.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$999.78
|
|
|
EVASC RPR A-AO NDGFT RPT
|
Facility
|
OP
|
$2,090.00
|
|
|
Service Code
|
HCPCS 34702
|
| Hospital Charge Code |
76101346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.70 |
| Max. Negotiated Rate |
$2,006.40 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Anthem Medicaid |
$718.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$1,734.70
|
| Rate for Payer: First Health Commercial |
$1,985.50
|
| Rate for Payer: Humana Commercial |
$1,776.50
|
| Rate for Payer: Humana KY Medicaid |
$718.75
|
| Rate for Payer: Kentucky WC Medicaid |
$726.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,713.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,542.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,839.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,567.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.90
|
| Rate for Payer: PHCS Commercial |
$2,006.40
|
| Rate for Payer: United Healthcare All Payer |
$1,839.20
|
|
|
EVASC RPR A-AO NDGFT RPT
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 34702
|
| Hospital Charge Code |
76101346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.50 |
| Max. Negotiated Rate |
$3,384.08 |
| Rate for Payer: Anthem Medicaid |
$1,480.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,090.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$3,384.08
|
| Rate for Payer: Humana Medicaid |
$1,480.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,468.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,510.10
|
| Rate for Payer: Molina Healthcare Passport |
$1,480.49
|
| Rate for Payer: Multiplan PHCS |
$1,254.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,463.00
|
| Rate for Payer: UHCCP Medicaid |
$731.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,495.29
|
|
|
EVASC RPR A-AO NDGFT RPT
|
Facility
|
IP
|
$2,090.00
|
|
|
Service Code
|
HCPCS 34702
|
| Hospital Charge Code |
76101346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$271.70 |
| Max. Negotiated Rate |
$2,006.40 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,630.20
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$1,734.70
|
| Rate for Payer: First Health Commercial |
$1,985.50
|
| Rate for Payer: Humana Commercial |
$1,776.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,713.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,542.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,839.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,567.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.90
|
| Rate for Payer: PHCS Commercial |
$2,006.40
|
| Rate for Payer: United Healthcare All Payer |
$1,839.20
|
|
|
EVASC RPR A-AO NDGFT RPT(P
|
Professional
|
Both
|
$2,090.00
|
|
|
Service Code
|
HCPCS 34702
|
| Hospital Charge Code |
761P1346
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$731.50 |
| Max. Negotiated Rate |
$3,384.08 |
| Rate for Payer: Anthem Medicaid |
$1,480.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,090.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cash Price |
$1,045.00
|
| Rate for Payer: Cigna Commercial |
$3,384.08
|
| Rate for Payer: Humana Medicaid |
$1,480.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2,468.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,510.10
|
| Rate for Payer: Molina Healthcare Passport |
$1,480.49
|
| Rate for Payer: Multiplan PHCS |
$1,254.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,463.00
|
| Rate for Payer: UHCCP Medicaid |
$731.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,495.29
|
|
|
EVASC RPR A-BIILIAC RPT
|
Facility
|
IP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 34706
|
| Hospital Charge Code |
76101348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
EVASC RPR A-BIILIAC RPT
|
Facility
|
OP
|
$2,575.00
|
|
|
Service Code
|
HCPCS 34706
|
| Hospital Charge Code |
76101348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.75 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,982.75
|
| Rate for Payer: Anthem Medicaid |
$885.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,008.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$2,137.25
|
| Rate for Payer: First Health Commercial |
$2,446.25
|
| Rate for Payer: Humana Commercial |
$2,188.75
|
| Rate for Payer: Humana KY Medicaid |
$885.54
|
| Rate for Payer: Kentucky WC Medicaid |
$894.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,111.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,900.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$772.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$903.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,266.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,931.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$515.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$334.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.25
|
| Rate for Payer: PHCS Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare All Payer |
$2,266.00
|
|
|
EVASC RPR A-BIILIAC RPT
|
Professional
|
Both
|
$2,575.00
|
|
|
Service Code
|
HCPCS 34706
|
| Hospital Charge Code |
76101348
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$901.25 |
| Max. Negotiated Rate |
$4,233.07 |
| Rate for Payer: Anthem Medicaid |
$1,851.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,575.00
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cash Price |
$1,287.50
|
| Rate for Payer: Cigna Commercial |
$4,233.07
|
| Rate for Payer: Humana Medicaid |
$1,851.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$3,088.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,888.07
|
| Rate for Payer: Molina Healthcare Passport |
$1,851.05
|
| Rate for Payer: Multiplan PHCS |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,802.50
|
| Rate for Payer: UHCCP Medicaid |
$901.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,869.56
|
|
