|
ELECTRONIC COMPATIBILITY EA UN
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
30001239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.75
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
ELECTRON PLANNING CODE
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
33300012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$430.80 |
| Max. Negotiated Rate |
$1,378.56 |
| Rate for Payer: Aetna Commercial |
$1,105.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,120.08
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cigna Commercial |
$1,191.88
|
| Rate for Payer: First Health Commercial |
$1,364.20
|
| Rate for Payer: Humana Commercial |
$1,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,177.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,077.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,249.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$990.84
|
| Rate for Payer: PHCS Commercial |
$1,378.56
|
| Rate for Payer: United Healthcare All Payer |
$1,263.68
|
|
|
ELECTRON PLANNING CODE
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
33300012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$861.60 |
| Rate for Payer: Aetna Commercial |
$191.62
|
| Rate for Payer: Ambetter Exchange |
$87.21
|
| Rate for Payer: Anthem Medicaid |
$149.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.65
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cigna Commercial |
$265.64
|
| Rate for Payer: Healthspan PPO |
$161.59
|
| Rate for Payer: Humana Medicaid |
$149.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.96
|
| Rate for Payer: Molina Healthcare Passport |
$149.96
|
| Rate for Payer: Multiplan PHCS |
$861.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.37
|
| Rate for Payer: UHCCP Medicaid |
$502.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.21
|
|
|
ELECTRON PLANNING CODE
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
33300012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,378.56 |
| Rate for Payer: Aetna Commercial |
$1,105.72
|
| Rate for Payer: Anthem Medicaid |
$493.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,120.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cigna Commercial |
$1,191.88
|
| Rate for Payer: First Health Commercial |
$1,364.20
|
| Rate for Payer: Humana Commercial |
$1,220.60
|
| Rate for Payer: Humana KY Medicaid |
$493.84
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$498.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,177.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$503.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,077.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,148.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,249.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$990.84
|
| Rate for Payer: PHCS Commercial |
$1,378.56
|
| Rate for Payer: United Healthcare All Payer |
$1,263.68
|
|
|
ELECTRON PLANNING CODE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
333P0012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$265.64 |
| Rate for Payer: Aetna Commercial |
$191.62
|
| Rate for Payer: Ambetter Exchange |
$87.21
|
| Rate for Payer: Anthem Medicaid |
$149.96
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$104.65
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$265.64
|
| Rate for Payer: Healthspan PPO |
$161.59
|
| Rate for Payer: Humana Medicaid |
$149.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.99
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.96
|
| Rate for Payer: Molina Healthcare Passport |
$149.96
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$113.37
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.46
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.21
|
|
|
ELECTRON PLANNING CODE(T
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
333T0012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
ELECTRON PLANNING CODE(T
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
333T0012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$887.34
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
ELECTRON SETUP-C
|
Professional
|
Both
|
$2,111.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$1,266.60 |
| Rate for Payer: Aetna Commercial |
$743.64
|
| Rate for Payer: Ambetter Exchange |
$394.41
|
| Rate for Payer: Anthem Medicaid |
$243.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$394.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$394.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$473.29
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$582.91
|
| Rate for Payer: Healthspan PPO |
$627.13
|
| Rate for Payer: Humana Medicaid |
$243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$394.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.86
|
| Rate for Payer: Molina Healthcare Passport |
$243.00
|
| Rate for Payer: Multiplan PHCS |
$1,266.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$512.73
|
| Rate for Payer: UHCCP Medicaid |
$738.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$394.41
|
|
|
ELECTRON SETUP-C
|
Facility
|
OP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem Medicaid |
$725.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Humana KY Medicaid |
$725.97
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$733.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
ELECTRON SETUP-C
|
Facility
|
IP
|
$2,111.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
33300003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$633.30 |
| Max. Negotiated Rate |
$2,026.56 |
| Rate for Payer: Aetna Commercial |
$1,625.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.58
|
| Rate for Payer: Cash Price |
$1,055.50
|
| Rate for Payer: Cigna Commercial |
$1,752.13
|
| Rate for Payer: First Health Commercial |
$2,005.45
|
| Rate for Payer: Humana Commercial |
$1,794.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,731.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,583.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,836.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.59
|
| Rate for Payer: PHCS Commercial |
$2,026.56
|
| Rate for Payer: United Healthcare All Payer |
$1,857.68
|
|
|
ELECTRON SETUP-C(P
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
333P0003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$743.64 |
| Rate for Payer: Aetna Commercial |
$743.64
|
| Rate for Payer: Ambetter Exchange |
$394.41
|
| Rate for Payer: Anthem Medicaid |
$243.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$394.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$394.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$473.29
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cigna Commercial |
$582.91
|
| Rate for Payer: Healthspan PPO |
$627.13
|
| Rate for Payer: Humana Medicaid |
$243.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$394.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$394.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.86
|
| Rate for Payer: Molina Healthcare Passport |
$243.00
|
| Rate for Payer: Multiplan PHCS |
$240.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$512.73
|
| Rate for Payer: UHCCP Medicaid |
$140.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$245.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$394.41
|
|
|
ELECTRON SETUP-C(T
|
Facility
|
OP
|
$1,711.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
333T0003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,642.56 |
| Rate for Payer: Aetna Commercial |
$1,317.47
|
| Rate for Payer: Anthem Medicaid |
$588.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,420.13
|
| Rate for Payer: First Health Commercial |
$1,625.45
|
| Rate for Payer: Humana Commercial |
$1,454.35
|
| Rate for Payer: Humana KY Medicaid |
$588.41
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$594.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,403.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.59
|
| Rate for Payer: PHCS Commercial |
$1,642.56
|
| Rate for Payer: United Healthcare All Payer |
$1,505.68
|
|
|
ELECTRON SETUP-C(T
|
Facility
|
IP
|
$1,711.00
|
|
|
Service Code
|
HCPCS 77290
|
| Hospital Charge Code |
333T0003
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$513.30 |
| Max. Negotiated Rate |
$1,642.56 |
| Rate for Payer: Aetna Commercial |
$1,317.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.58
|
| Rate for Payer: Cash Price |
$855.50
|
| Rate for Payer: Cigna Commercial |
$1,420.13
|
| Rate for Payer: First Health Commercial |
$1,625.45
|
| Rate for Payer: Humana Commercial |
$1,454.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,403.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,368.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,488.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.59
|
| Rate for Payer: PHCS Commercial |
$1,642.56
|
| Rate for Payer: United Healthcare All Payer |
$1,505.68
|
|
|
ELECTROPHYSIOLOGY EVALUATION
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
HCPCS 93641
|
| Hospital Charge Code |
48000098
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$1,566.72 |
| Rate for Payer: Aetna Commercial |
$1,256.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,272.96
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,354.56
|
| Rate for Payer: First Health Commercial |
$1,550.40
|
| Rate for Payer: Humana Commercial |
$1,387.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,338.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,204.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,419.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,126.08
|
| Rate for Payer: PHCS Commercial |
$1,566.72
|
| Rate for Payer: United Healthcare All Payer |
$1,436.16
|
|
|
ELECTROPHYSIOLOGY EVALUATION
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
HCPCS 93641
|
| Hospital Charge Code |
48000098
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$1,566.72 |
| Rate for Payer: Aetna Commercial |
$1,256.64
|
| Rate for Payer: Anthem Medicaid |
$561.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,272.96
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cigna Commercial |
$1,354.56
|
| Rate for Payer: First Health Commercial |
$1,550.40
|
| Rate for Payer: Humana Commercial |
$1,387.20
|
| Rate for Payer: Humana KY Medicaid |
$561.24
|
| Rate for Payer: Kentucky WC Medicaid |
$566.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,338.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,204.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$572.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,436.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,419.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,126.08
|
| Rate for Payer: PHCS Commercial |
$1,566.72
|
| Rate for Payer: United Healthcare All Payer |
$1,436.16
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Ambetter Exchange |
$13.28
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.94
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$321.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.26
|
| Rate for Payer: UHCCP Medicaid |
$187.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.28
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$133.43 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem Medicaid |
$133.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Humana KY Medicaid |
$133.43
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$134.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$136.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$232.80 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Ambetter Exchange |
$13.28
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.94
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$232.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.26
|
| Rate for Payer: UHCCP Medicaid |
$135.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.28
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$160.50 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$160.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
92000001
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$68.09 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$152.46
|
| Rate for Payer: Anthem Medicaid |
$68.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$154.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$164.34
|
| Rate for Payer: First Health Commercial |
$188.10
|
| Rate for Payer: Humana Commercial |
$168.30
|
| Rate for Payer: Humana KY Medicaid |
$68.09
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$68.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$162.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$174.24
|
| Rate for Payer: Ohio Health Group HMO |
$148.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.62
|
| Rate for Payer: PHCS Commercial |
$190.08
|
| Rate for Payer: United Healthcare All Payer |
$174.24
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$372.48 |
| Rate for Payer: Aetna Commercial |
$298.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$302.64
|
| Rate for Payer: Cash Price |
$194.00
|
| Rate for Payer: Cigna Commercial |
$322.04
|
| Rate for Payer: First Health Commercial |
$368.60
|
| Rate for Payer: Humana Commercial |
$329.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$318.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$286.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$341.44
|
| Rate for Payer: Ohio Health Group HMO |
$291.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$310.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$337.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$267.72
|
| Rate for Payer: PHCS Commercial |
$372.48
|
| Rate for Payer: United Healthcare All Payer |
$341.44
|
|
|
ELECTRO-UROFLOWMETRY FIRST
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
76102071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$183.99 |
| Max. Negotiated Rate |
$513.60 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Anthem Medicaid |
$183.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$417.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cash Price |
$267.50
|
| Rate for Payer: Cigna Commercial |
$444.05
|
| Rate for Payer: First Health Commercial |
$508.25
|
| Rate for Payer: Humana Commercial |
$454.75
|
| Rate for Payer: Humana KY Medicaid |
$183.99
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$185.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$438.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$394.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$470.80
|
| Rate for Payer: Ohio Health Group HMO |
$401.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$369.15
|
| Rate for Payer: PHCS Commercial |
$513.60
|
| Rate for Payer: United Healthcare All Payer |
$470.80
|
|
|
ELECTRO-UROFLOWMETRY FIRST(P
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761P2072
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$135.73 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Ambetter Exchange |
$13.28
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.94
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$75.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.26
|
| Rate for Payer: UHCCP Medicaid |
$43.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.28
|
|
|
ELECTRO-UROFLOWMETRY FIRST(P
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 51741
|
| Hospital Charge Code |
761P2071
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$135.73
|
| Rate for Payer: Ambetter Exchange |
$13.28
|
| Rate for Payer: Anthem Medicaid |
$62.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$13.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$15.94
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$117.22
|
| Rate for Payer: Healthspan PPO |
$108.53
|
| Rate for Payer: Humana Medicaid |
$62.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$21.51
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$13.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.80
|
| Rate for Payer: Molina Healthcare Passport |
$62.55
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$17.26
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$13.28
|
|
