|
EVAC THOMBOSED HEMORRHOID
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
76101914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$290.50
|
| Rate for Payer: First Health Commercial |
$332.50
|
| Rate for Payer: Humana Commercial |
$297.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$258.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.00
|
| Rate for Payer: Ohio Health Group HMO |
$262.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.50
|
| Rate for Payer: PHCS Commercial |
$336.00
|
| Rate for Payer: United Healthcare All Payer |
$308.00
|
|
|
EVAC THOMBOSED HEMORRHOID(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 46083
|
| Hospital Charge Code |
761P1914
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$58.46 |
| Max. Negotiated Rate |
$220.83 |
| Rate for Payer: Aetna Commercial |
$149.92
|
| Rate for Payer: Ambetter Exchange |
$104.29
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$64.05
|
| Rate for Payer: Anthem Medicaid |
$58.46
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.15
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$220.83
|
| Rate for Payer: Healthspan PPO |
$200.46
|
| Rate for Payer: Humana Medicaid |
$58.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.17
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$59.63
|
| Rate for Payer: Molina Healthcare Passport |
$58.46
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.58
|
| Rate for Payer: UHCCP Medicaid |
$67.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$59.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.29
|
|
|
EVACUATE MOLE OF UTERUS
|
Professional
|
Both
|
$5,011.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
72000030
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$214.05 |
| Max. Negotiated Rate |
$3,006.60 |
| Rate for Payer: Aetna Commercial |
$754.24
|
| Rate for Payer: Ambetter Exchange |
$503.85
|
| Rate for Payer: Anthem Medicaid |
$214.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$604.62
|
| Rate for Payer: Cash Price |
$2,505.50
|
| Rate for Payer: Cash Price |
$2,505.50
|
| Rate for Payer: Cigna Commercial |
$682.16
|
| Rate for Payer: Healthspan PPO |
$547.44
|
| Rate for Payer: Humana Medicaid |
$214.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$622.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$503.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.33
|
| Rate for Payer: Molina Healthcare Passport |
$214.05
|
| Rate for Payer: Multiplan PHCS |
$3,006.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$655.00
|
| Rate for Payer: UHCCP Medicaid |
$1,753.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.85
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$5,011.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
72000030
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,503.30 |
| Max. Negotiated Rate |
$4,810.56 |
| Rate for Payer: Aetna Commercial |
$3,858.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.58
|
| Rate for Payer: Cash Price |
$2,505.50
|
| Rate for Payer: Cigna Commercial |
$4,159.13
|
| Rate for Payer: First Health Commercial |
$4,760.45
|
| Rate for Payer: Humana Commercial |
$4,259.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,109.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,698.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,503.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,758.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.59
|
| Rate for Payer: PHCS Commercial |
$4,810.56
|
| Rate for Payer: United Healthcare All Payer |
$4,409.68
|
|
|
EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$5,011.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
72000030
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,723.28 |
| Max. Negotiated Rate |
$4,810.56 |
| Rate for Payer: Aetna Commercial |
$3,858.47
|
| Rate for Payer: Anthem Medicaid |
$1,723.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,908.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$2,505.50
|
| Rate for Payer: Cash Price |
$2,505.50
|
| Rate for Payer: Cigna Commercial |
$4,159.13
|
| Rate for Payer: First Health Commercial |
$4,760.45
|
| Rate for Payer: Humana Commercial |
$4,259.35
|
| Rate for Payer: Humana KY Medicaid |
$1,723.28
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,740.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,109.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,698.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,757.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,409.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,758.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,008.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,359.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,457.59
|
| Rate for Payer: PHCS Commercial |
$4,810.56
|
| Rate for Payer: United Healthcare All Payer |
$4,409.68
|
|
|
EVACUATE MOLE OF UTERUS(P
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
720P0030
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$214.05 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$754.24
|
| Rate for Payer: Ambetter Exchange |
$503.85
|
| Rate for Payer: Anthem Medicaid |
$214.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$503.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$503.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$604.62
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cigna Commercial |
$682.16
|
| Rate for Payer: Healthspan PPO |
$547.44
|
| Rate for Payer: Humana Medicaid |
$214.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$622.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$503.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$503.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.33
|
| Rate for Payer: Molina Healthcare Passport |
$214.05
|
| Rate for Payer: Multiplan PHCS |
$768.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$655.00
|
| Rate for Payer: UHCCP Medicaid |
$448.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.19
|
| Rate for Payer: Wellcare Medicare Advantage |
$503.85
|
|
|
EVACUATE MOLE OF UTERUS(T
|
Facility
|
IP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
720T0030
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$3,581.76 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,119.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EVACUATE MOLE OF UTERUS(T
|
Facility
|
OP
|
$3,731.00
|
|
|
Service Code
|
HCPCS 59870
|
| Hospital Charge Code |
720T0030
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,283.09 |
| Max. Negotiated Rate |
$4,112.95 |
| Rate for Payer: Aetna Commercial |
$2,872.87
|
| Rate for Payer: Anthem Medicaid |
$1,283.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,937.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,910.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,112.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,966.06
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cash Price |
$1,865.50
|
| Rate for Payer: Cigna Commercial |
$3,096.73
|
| Rate for Payer: First Health Commercial |
$3,544.45
|
| Rate for Payer: Humana Commercial |
$3,171.35
|
| Rate for Payer: Humana KY Medicaid |
$1,283.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,937.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,296.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,059.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,753.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,525.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,308.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,283.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,798.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,984.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,245.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,574.39
|
| Rate for Payer: PHCS Commercial |
$3,581.76
|
| Rate for Payer: United Healthcare All Payer |
$3,283.28
|
|
|
EVACUATION OF SUBUNGUAL HEMATOMA
|
Facility
|
OP
|
$166.74
|
|
|
Service Code
|
CPT 11740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.10 |
| Max. Negotiated Rate |
$166.74 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
|
|
EVAL CTL AUD FUNC W RPT INT HR
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 92620
|
| Hospital Charge Code |
47000021
|
|
Hospital Revenue Code
|
470
|
| 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
|
|
|
EVAL CTL AUD FUNC W RPT INT HR
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 92620
|
| Hospital Charge Code |
47000021
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| 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 |
$144.57
|
| 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 |
$173.48
|
| 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
|
|
|
EVAL CTL AUD FUN W RPT AD15MIN
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
HCPCS 92621
|
| Hospital Charge Code |
47000022
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.54
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
EVAL CTL AUD FUN W RPT AD15MIN
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
HCPCS 92621
|
| Hospital Charge Code |
47000022
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$41.28 |
| Rate for Payer: Aetna Commercial |
$33.11
|
| Rate for Payer: Anthem Medicaid |
$14.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$33.54
|
| Rate for Payer: Cash Price |
$21.50
|
| Rate for Payer: Cigna Commercial |
$35.69
|
| Rate for Payer: First Health Commercial |
$40.85
|
| Rate for Payer: Humana Commercial |
$36.55
|
| Rate for Payer: Humana KY Medicaid |
$14.79
|
| Rate for Payer: Kentucky WC Medicaid |
$14.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$35.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$31.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$37.84
|
| Rate for Payer: Ohio Health Group HMO |
$32.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$29.67
|
| Rate for Payer: PHCS Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Payer |
$37.84
|
|
|
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 |
$224.07 |
| Rate for Payer: Aetna Commercial |
$224.07
|
| Rate for Payer: Ambetter Exchange |
$115.69
|
| Rate for Payer: Anthem Medicaid |
$76.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$115.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.69
|
| 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 |
$150.40
|
| Rate for Payer: UHCCP Medicaid |
$85.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$77.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.69
|
|
|
EVAL PRESC SPEECH DEV 1ST HR
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
HCPCS 92607
|
| Hospital Charge Code |
44000010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.56
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
EVAL PRESC SPEECH DEV 1ST HR
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
HCPCS 92607
|
| Hospital Charge Code |
44000010
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$241.92 |
| Rate for Payer: Aetna Commercial |
$194.04
|
| Rate for Payer: Anthem Medicaid |
$86.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$196.56
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$209.16
|
| Rate for Payer: First Health Commercial |
$239.40
|
| Rate for Payer: Humana Commercial |
$214.20
|
| Rate for Payer: Humana KY Medicaid |
$86.66
|
| Rate for Payer: Kentucky WC Medicaid |
$87.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$206.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$185.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$221.76
|
| Rate for Payer: Ohio Health Group HMO |
$189.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$201.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$219.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.88
|
| Rate for Payer: PHCS Commercial |
$241.92
|
| Rate for Payer: United Healthcare All Payer |
$221.76
|
|
|
EVALUATE PT USE OF INHALER
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
76102496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$183.00 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: Ambetter Exchange |
$15.99
|
| Rate for Payer: Anthem Medicaid |
$12.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.19
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$15.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.90
|
| Rate for Payer: Molina Healthcare Passport |
$12.65
|
| Rate for Payer: Multiplan PHCS |
$183.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$20.79
|
| Rate for Payer: UHCCP Medicaid |
$106.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.99
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
41000081
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$263.10 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| 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 |
$187.93
|
| 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 |
$225.52
|
| 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 |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| 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 |
41000081
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$78.90 |
| 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 |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
76102496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
76102496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$292.80 |
| Rate for Payer: Aetna Commercial |
$234.85
|
| Rate for Payer: Anthem Medicaid |
$104.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cash Price |
$152.50
|
| Rate for Payer: Cigna Commercial |
$253.15
|
| Rate for Payer: First Health Commercial |
$289.75
|
| Rate for Payer: Humana Commercial |
$259.25
|
| Rate for Payer: Humana KY Medicaid |
$104.89
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$105.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$250.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$225.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$268.40
|
| Rate for Payer: Ohio Health Group HMO |
$228.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$244.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$210.45
|
| Rate for Payer: PHCS Commercial |
$292.80
|
| Rate for Payer: United Healthcare All Payer |
$268.40
|
|
|
EVALUATE PT USE OF INHALER
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
92000011
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$263.10 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Anthem Medicaid |
$90.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$205.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| 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 |
$187.93
|
| 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 |
$225.52
|
| 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 |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| 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 |
$78.90 |
| 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 |
$210.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.47
|
| Rate for Payer: PHCS Commercial |
$252.48
|
| Rate for Payer: United Healthcare All Payer |
$231.44
|
|
|
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 |
$22.65 |
| Rate for Payer: Aetna Commercial |
$22.65
|
| Rate for Payer: Ambetter Exchange |
$15.99
|
| Rate for Payer: Anthem Medicaid |
$12.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$19.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$15.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.99
|
| 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 |
$20.79
|
| Rate for Payer: UHCCP Medicaid |
$8.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$12.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.99
|
|
|
EVALUATE PT USE OF INHALER(T
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
761T2496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.29 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$263.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.71
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$187.93
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
