|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
922P0010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$149.08 |
| Rate for Payer: Ambetter Exchange |
$85.10
|
| Rate for Payer: Anthem Medicaid |
$69.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.12
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cash Price |
$42.50
|
| Rate for Payer: Cigna Commercial |
$149.08
|
| Rate for Payer: Healthspan PPO |
$85.59
|
| Rate for Payer: Humana Medicaid |
$69.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.38
|
| Rate for Payer: Molina Healthcare Passport |
$69.00
|
| Rate for Payer: Multiplan PHCS |
$51.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$110.63
|
| Rate for Payer: UHCCP Medicaid |
$29.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.10
|
|
|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
92200010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem Medicaid |
$157.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.46
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Humana KY Medicaid |
$157.16
|
| Rate for Payer: Kentucky WC Medicaid |
$158.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$397.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.33
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
922T0010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
92200010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$274.20 |
| Rate for Payer: Ambetter Exchange |
$85.10
|
| Rate for Payer: Anthem Medicaid |
$69.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$85.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$85.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$102.12
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$149.08
|
| Rate for Payer: Healthspan PPO |
$85.59
|
| Rate for Payer: Humana Medicaid |
$69.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$56.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$85.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$70.38
|
| Rate for Payer: Molina Healthcare Passport |
$69.00
|
| Rate for Payer: Multiplan PHCS |
$274.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$110.63
|
| Rate for Payer: UHCCP Medicaid |
$159.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$69.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$85.10
|
|
|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
92200010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$137.10 |
| Max. Negotiated Rate |
$438.72 |
| Rate for Payer: Aetna Commercial |
$351.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.46
|
| Rate for Payer: Cash Price |
$228.50
|
| Rate for Payer: Cigna Commercial |
$379.31
|
| Rate for Payer: First Health Commercial |
$434.15
|
| Rate for Payer: Humana Commercial |
$388.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$374.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.16
|
| Rate for Payer: Ohio Health Group HMO |
$342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$397.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$315.33
|
| Rate for Payer: PHCS Commercial |
$438.72
|
| Rate for Payer: United Healthcare All Payer |
$402.16
|
|
|
EMG EA EXT CONDUCT COMPLTE 5 >
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 95886
|
| Hospital Charge Code |
922T0010
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$297.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$323.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$256.68
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
EMG EA EXT CONDUCTTN LIMITED
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem Medicaid |
$191.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Humana KY Medicaid |
$191.90
|
| Rate for Payer: Kentucky WC Medicaid |
$193.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$195.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
EMG EA EXT CONDUCTTN LIMITED
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$167.40 |
| Max. Negotiated Rate |
$535.68 |
| Rate for Payer: Aetna Commercial |
$429.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$435.24
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$463.14
|
| Rate for Payer: First Health Commercial |
$530.10
|
| Rate for Payer: Humana Commercial |
$474.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$457.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$411.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$167.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$491.04
|
| Rate for Payer: Ohio Health Group HMO |
$418.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$446.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$385.02
|
| Rate for Payer: PHCS Commercial |
$535.68
|
| Rate for Payer: United Healthcare All Payer |
$491.04
|
|
|
EMG EA EXT CONDUCTTN LIMITED
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
92200009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Ambetter Exchange |
$53.79
|
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.55
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cigna Commercial |
$94.15
|
| Rate for Payer: Healthspan PPO |
$53.96
|
| Rate for Payer: Humana Medicaid |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.22
|
| Rate for Payer: Molina Healthcare Passport |
$43.35
|
| Rate for Payer: Multiplan PHCS |
$334.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.93
|
| Rate for Payer: UHCCP Medicaid |
$195.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.79
|
|
|
EMG EA EXT CONDUCTTN LIMITED(P
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
922P0009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Ambetter Exchange |
$53.79
|
| Rate for Payer: Anthem Medicaid |
$43.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$53.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$53.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$64.55
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$94.15
|
| Rate for Payer: Healthspan PPO |
$53.96
|
| Rate for Payer: Humana Medicaid |
$43.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$20.95
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$53.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$53.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.22
|
| Rate for Payer: Molina Healthcare Passport |
$43.35
|
| Rate for Payer: Multiplan PHCS |
$154.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$69.93
|
| Rate for Payer: UHCCP Medicaid |
$90.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$53.79
|
|
|
EMG EA EXT CONDUCTTN LIMITED(T
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
922T0009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
EMG EA EXT CONDUCTTN LIMITED(T
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 95885
|
| Hospital Charge Code |
922T0009
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
EMG FACIAL NERVES UNILATERAL
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$115.80 |
| Max. Negotiated Rate |
$370.56 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.08
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$320.38
|
| Rate for Payer: First Health Commercial |
$366.70
|
| Rate for Payer: Humana Commercial |
$328.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$316.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$339.68
|
| Rate for Payer: Ohio Health Group HMO |
$289.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$335.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.34
|
| Rate for Payer: PHCS Commercial |
$370.56
|
| Rate for Payer: United Healthcare All Payer |
$339.68
|
|
|
EMG FACIAL NERVES UNILATERAL
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$231.60 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Ambetter Exchange |
$94.12
|
| Rate for Payer: Anthem Medicaid |
$50.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$112.94
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$102.53
|
| Rate for Payer: Healthspan PPO |
$95.47
|
| Rate for Payer: Humana Medicaid |
$50.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.70
|
| Rate for Payer: Molina Healthcare Passport |
$50.69
|
| Rate for Payer: Multiplan PHCS |
$231.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.36
|
| Rate for Payer: UHCCP Medicaid |
$135.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.12
|
|
|
EMG FACIAL NERVES UNILATERAL
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
92200005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$132.75 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$297.22
|
| Rate for Payer: Anthem Medicaid |
$132.75
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Cigna Commercial |
$320.38
|
| Rate for Payer: First Health Commercial |
$366.70
|
| Rate for Payer: Humana Commercial |
$328.10
|
| Rate for Payer: Humana KY Medicaid |
$132.75
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$134.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$316.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$284.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$339.68
|
| Rate for Payer: Ohio Health Group HMO |
$289.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$308.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$335.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$266.34
|
| Rate for Payer: PHCS Commercial |
$370.56
|
| Rate for Payer: United Healthcare All Payer |
$339.68
|
|
|
EMG FACIAL NERVES UNILATERAL(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
922P0005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Ambetter Exchange |
$94.12
|
| Rate for Payer: Anthem Medicaid |
$50.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$94.12
|
| Rate for Payer: Buckeye Medicare Advantage |
$94.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$112.94
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$102.53
|
| Rate for Payer: Healthspan PPO |
$95.47
|
| Rate for Payer: Humana Medicaid |
$50.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$48.81
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$94.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$51.70
|
| Rate for Payer: Molina Healthcare Passport |
$50.69
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.36
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$51.20
|
| Rate for Payer: Wellcare Medicare Advantage |
$94.12
|
|
|
EMG FACIAL NERVES UNILATERAL(T
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
922T0005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
EMG FACIAL NERVES UNILATERAL(T
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 95867
|
| Hospital Charge Code |
922T0005
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$61.80 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$164.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$179.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.14
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
EMG GUID CHEMONERVATION
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
EMG GUID CHEMONERVATION
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$85.71 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: Ambetter Exchange |
$65.93
|
| Rate for Payer: Anthem Medicaid |
$21.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.12
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$51.73
|
| Rate for Payer: Healthspan PPO |
$58.09
|
| Rate for Payer: Humana Medicaid |
$21.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.88
|
| Rate for Payer: Molina Healthcare Passport |
$21.45
|
| Rate for Payer: Multiplan PHCS |
$47.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.71
|
| Rate for Payer: UHCCP Medicaid |
$27.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.93
|
|
|
EMG GUID CHEMONERVATION
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
92200008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$23.70 |
| Max. Negotiated Rate |
$75.84 |
| Rate for Payer: Aetna Commercial |
$60.83
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$61.62
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Cigna Commercial |
$65.57
|
| Rate for Payer: First Health Commercial |
$75.05
|
| Rate for Payer: Humana Commercial |
$67.15
|
| Rate for Payer: Humana KY Medicaid |
$27.17
|
| Rate for Payer: Kentucky WC Medicaid |
$27.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$64.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$69.52
|
| Rate for Payer: Ohio Health Group HMO |
$59.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.51
|
| Rate for Payer: PHCS Commercial |
$75.84
|
| Rate for Payer: United Healthcare All Payer |
$69.52
|
|
|
EMG GUID CHEMONERVATION(P
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
922P0008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$85.71 |
| Rate for Payer: Aetna Commercial |
$65.95
|
| Rate for Payer: Ambetter Exchange |
$65.93
|
| Rate for Payer: Anthem Medicaid |
$21.45
|
| Rate for Payer: Buckeye Individual/Medicaid |
$65.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$65.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$79.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$51.73
|
| Rate for Payer: Healthspan PPO |
$58.09
|
| Rate for Payer: Humana Medicaid |
$21.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$22.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$65.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.88
|
| Rate for Payer: Molina Healthcare Passport |
$21.45
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$85.71
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$65.93
|
|
|
EMG GUID CHEMONERVATION(T
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
922T0008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem Medicaid |
$6.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.82
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Humana KY Medicaid |
$6.53
|
| Rate for Payer: Kentucky WC Medicaid |
$6.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EMG GUID CHEMONERVATION(T
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
HCPCS 95874
|
| Hospital Charge Code |
922T0008
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$18.24 |
| Rate for Payer: Aetna Commercial |
$14.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14.82
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna Commercial |
$15.77
|
| Rate for Payer: First Health Commercial |
$18.05
|
| Rate for Payer: Humana Commercial |
$16.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$16.72
|
| Rate for Payer: Ohio Health Group HMO |
$14.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13.11
|
| Rate for Payer: PHCS Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Payer |
$16.72
|
|
|
EMG LIMITED STUDY
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
HCPCS 95870
|
| Hospital Charge Code |
92200007
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$248.64 |
| Rate for Payer: Aetna Commercial |
$199.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$202.02
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cigna Commercial |
$214.97
|
| Rate for Payer: First Health Commercial |
$246.05
|
| Rate for Payer: Humana Commercial |
$220.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$212.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$191.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$227.92
|
| Rate for Payer: Ohio Health Group HMO |
$194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$207.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$225.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$178.71
|
| Rate for Payer: PHCS Commercial |
$248.64
|
| Rate for Payer: United Healthcare All Payer |
$227.92
|
|
