|
FACIAL BONES COMPLETE 3 VIEW(T
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
320T0012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
FACIAL BONES COMPLETE 3 VIEW(T
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
320T0012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$422.40 |
| Rate for Payer: Aetna Commercial |
$338.80
|
| Rate for Payer: Anthem Medicaid |
$151.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$365.20
|
| Rate for Payer: First Health Commercial |
$418.00
|
| Rate for Payer: Humana Commercial |
$374.00
|
| Rate for Payer: Humana KY Medicaid |
$151.32
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$152.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.20
|
| Rate for Payer: Ohio Health Group HMO |
$330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$136.40
|
| Rate for Payer: PHCS Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Payer |
$387.20
|
|
|
FACIAL NERVE FUNCTION STUDY
|
Facility
|
OP
|
$692.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
76102451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.02 |
| Max. Negotiated Rate |
$664.80 |
| Rate for Payer: Aetna Commercial |
$533.22
|
| Rate for Payer: Anthem Medicaid |
$238.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cigna Commercial |
$574.78
|
| Rate for Payer: First Health Commercial |
$657.88
|
| Rate for Payer: Humana Commercial |
$588.62
|
| Rate for Payer: Humana KY Medicaid |
$238.15
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$240.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$567.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$242.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.40
|
| Rate for Payer: Ohio Health Group HMO |
$519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.68
|
| Rate for Payer: PHCS Commercial |
$664.80
|
| Rate for Payer: United Healthcare All Payer |
$609.40
|
|
|
FACIAL NERVE FUNCTION STUDY
|
Professional
|
Both
|
$692.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
76102451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$692.50 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.69
|
| Rate for Payer: Anthem Medicaid |
$18.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$692.50
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cigna Commercial |
$91.53
|
| Rate for Payer: Healthspan PPO |
$73.45
|
| Rate for Payer: Humana Medicaid |
$18.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.20
|
| Rate for Payer: Molina Healthcare Passport |
$18.82
|
| Rate for Payer: Multiplan PHCS |
$415.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$484.75
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.01
|
|
|
FACIAL NERVE FUNCTION STUDY
|
Facility
|
IP
|
$692.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
76102451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.02 |
| Max. Negotiated Rate |
$664.80 |
| Rate for Payer: Aetna Commercial |
$533.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.15
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cigna Commercial |
$574.78
|
| Rate for Payer: First Health Commercial |
$657.88
|
| Rate for Payer: Humana Commercial |
$588.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$567.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$511.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$207.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$609.40
|
| Rate for Payer: Ohio Health Group HMO |
$519.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$138.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$90.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$214.68
|
| Rate for Payer: PHCS Commercial |
$664.80
|
| Rate for Payer: United Healthcare All Payer |
$609.40
|
|
|
FACIAL NERVE FUNCTION STUDY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
761P2451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.82 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.69
|
| Rate for Payer: Anthem Medicaid |
$18.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$91.53
|
| Rate for Payer: Healthspan PPO |
$73.45
|
| Rate for Payer: Humana Medicaid |
$18.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$19.20
|
| Rate for Payer: Molina Healthcare Passport |
$18.82
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$19.01
|
|
|
FACIAL NERVE FUNCTION STUDY(T
|
Facility
|
OP
|
$542.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
761T2451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.52 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$417.72
|
| Rate for Payer: Anthem Medicaid |
$186.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$271.25
|
| Rate for Payer: Cash Price |
$271.25
|
| Rate for Payer: Cigna Commercial |
$450.28
|
| Rate for Payer: First Health Commercial |
$515.38
|
| Rate for Payer: Humana Commercial |
$461.12
|
| Rate for Payer: Humana KY Medicaid |
$186.57
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$188.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$190.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.40
|
| Rate for Payer: Ohio Health Group HMO |
$406.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.18
|
| Rate for Payer: PHCS Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Payer |
$477.40
|
|
|
FACIAL NERVE FUNCTION STUDY(T
|
Facility
|
IP
|
$542.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
761T2451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.52 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$417.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.15
|
| Rate for Payer: Cash Price |
$271.25
|
| Rate for Payer: Cigna Commercial |
$450.28
|
| Rate for Payer: First Health Commercial |
$515.38
|
| Rate for Payer: Humana Commercial |
$461.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$444.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$400.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$477.40
|
| Rate for Payer: Ohio Health Group HMO |
$406.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$168.18
|
| Rate for Payer: PHCS Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Payer |
$477.40
|
|
|
FACILITY CHARGE LEVEL
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000323
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem Medicaid |
$76.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.16
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Humana KY Medicaid |
$76.35
|
| Rate for Payer: Kentucky WC Medicaid |
$77.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$77.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.82
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
FACILITY CHARGE LEVEL
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000323
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.88
|
| Rate for Payer: Anthem Medicaid |
$7.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$222.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$29.84
|
| Rate for Payer: Healthspan PPO |
$21.35
|
| Rate for Payer: Humana Medicaid |
$7.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.63
|
| Rate for Payer: Molina Healthcare Passport |
$7.48
|
| Rate for Payer: Multiplan PHCS |
$133.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.40
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.55
|
|
|
FACILITY CHARGE LEVEL
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000323
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$213.12 |
| Rate for Payer: Aetna Commercial |
$170.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$173.16
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$184.26
|
| Rate for Payer: First Health Commercial |
$210.90
|
| Rate for Payer: Humana Commercial |
$188.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$182.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$163.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$66.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$195.36
|
| Rate for Payer: Ohio Health Group HMO |
$166.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$44.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$28.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$68.82
|
| Rate for Payer: PHCS Commercial |
$213.12
|
| Rate for Payer: United Healthcare All Payer |
$195.36
|
|
|
FACILITY CHARGE LEVEL (P
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
510P0323
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.88
|
| Rate for Payer: Anthem Medicaid |
$7.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$222.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$29.84
|
| Rate for Payer: Healthspan PPO |
$21.35
|
| Rate for Payer: Humana Medicaid |
$7.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.63
|
| Rate for Payer: Molina Healthcare Passport |
$7.48
|
| Rate for Payer: Multiplan PHCS |
$133.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$155.40
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.55
|
|
|
FALLER STYLET F/COILED CATH
|
Facility
|
OP
|
$3,198.20
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.77 |
| Max. Negotiated Rate |
$3,070.27 |
| Rate for Payer: Aetna Commercial |
$2,462.61
|
| Rate for Payer: Anthem Medicaid |
$1,099.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.60
|
| Rate for Payer: Cash Price |
$1,599.10
|
| Rate for Payer: Cigna Commercial |
$2,654.51
|
| Rate for Payer: First Health Commercial |
$3,038.29
|
| Rate for Payer: Humana Commercial |
$2,718.47
|
| Rate for Payer: Humana KY Medicaid |
$1,099.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,622.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,360.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,814.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.44
|
| Rate for Payer: PHCS Commercial |
$3,070.27
|
| Rate for Payer: United Healthcare All Payer |
$2,814.42
|
|
|
FALLER STYLET F/COILED CATH
|
Facility
|
IP
|
$3,198.20
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.77 |
| Max. Negotiated Rate |
$3,070.27 |
| Rate for Payer: Aetna Commercial |
$2,462.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,494.60
|
| Rate for Payer: Cash Price |
$1,599.10
|
| Rate for Payer: Cigna Commercial |
$2,654.51
|
| Rate for Payer: First Health Commercial |
$3,038.29
|
| Rate for Payer: Humana Commercial |
$2,718.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,622.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,360.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,814.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,398.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$639.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$991.44
|
| Rate for Payer: PHCS Commercial |
$3,070.27
|
| Rate for Payer: United Healthcare All Payer |
$2,814.42
|
|
|
FAMILY PSYTX W/O PT 50 MIN
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
90000009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$57.66 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.66
|
| Rate for Payer: Anthem Medicaid |
$75.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$456.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$116.41
|
| Rate for Payer: Healthspan PPO |
$105.13
|
| Rate for Payer: Humana Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.24
|
| Rate for Payer: Molina Healthcare Passport |
$75.73
|
| Rate for Payer: Multiplan PHCS |
$273.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$319.20
|
| Rate for Payer: UHCCP Medicaid |
$60.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.49
|
|
|
FAMILY PSYTX W/O PT 50 MIN
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
90000009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna Commercial |
$351.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$355.68
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$378.48
|
| Rate for Payer: First Health Commercial |
$433.20
|
| Rate for Payer: Humana Commercial |
$387.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$336.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$401.28
|
| Rate for Payer: Ohio Health Group HMO |
$342.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.36
|
| Rate for Payer: PHCS Commercial |
$437.76
|
| Rate for Payer: United Healthcare All Payer |
$401.28
|
|
|
FAMILY PSYTX W/O PT 50 MIN
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
90000009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Aetna Commercial |
$351.12
|
| Rate for Payer: Anthem Medicaid |
$156.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$355.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$378.48
|
| Rate for Payer: First Health Commercial |
$433.20
|
| Rate for Payer: Humana Commercial |
$387.60
|
| Rate for Payer: Humana KY Medicaid |
$156.82
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$158.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$336.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$401.28
|
| Rate for Payer: Ohio Health Group HMO |
$342.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.36
|
| Rate for Payer: PHCS Commercial |
$437.76
|
| Rate for Payer: United Healthcare All Payer |
$401.28
|
|
|
FAMILY PSYTX W/O PT 50 MIN(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
900P0009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$57.66 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.66
|
| Rate for Payer: Anthem Medicaid |
$75.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$116.41
|
| Rate for Payer: Healthspan PPO |
$105.13
|
| Rate for Payer: Humana Medicaid |
$75.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.24
|
| Rate for Payer: Molina Healthcare Passport |
$75.73
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$60.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.49
|
|
|
FAMILY PSYTX W/O PT 50 MIN(T
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
900T0009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem Medicaid |
$88.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Humana KY Medicaid |
$88.04
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$88.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
FAMILY PSYTX W/O PT 50 MIN(T
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
900T0009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$245.76 |
| Rate for Payer: Aetna Commercial |
$197.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cigna Commercial |
$212.48
|
| Rate for Payer: First Health Commercial |
$243.20
|
| Rate for Payer: Humana Commercial |
$217.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$209.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$188.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$225.28
|
| Rate for Payer: Ohio Health Group HMO |
$192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$51.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$33.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.36
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
|
FAMILY THERAPY
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
90000010
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$453.00 |
| Rate for Payer: Aetna Commercial |
$161.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.71
|
| Rate for Payer: Anthem Medicaid |
$78.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$453.00
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$142.98
|
| Rate for Payer: Healthspan PPO |
$130.54
|
| Rate for Payer: Humana Medicaid |
$78.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.74
|
| Rate for Payer: Molina Healthcare Passport |
$78.18
|
| Rate for Payer: Multiplan PHCS |
$271.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$317.10
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.96
|
|
|
FAMILY THERAPY
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
90000010
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem Medicaid |
$155.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$137.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$193.02
|
| Rate for Payer: CareSource Just4Me Medicare |
$186.12
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Humana KY Medicaid |
$155.79
|
| Rate for Payer: Humana Medicare Advantage |
$137.87
|
| Rate for Payer: Kentucky WC Medicaid |
$157.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$158.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.43
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
FAMILY THERAPY
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
90000010
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$58.89 |
| Max. Negotiated Rate |
$434.88 |
| Rate for Payer: Aetna Commercial |
$348.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$353.34
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$375.99
|
| Rate for Payer: First Health Commercial |
$430.35
|
| Rate for Payer: Humana Commercial |
$385.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$371.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$334.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$398.64
|
| Rate for Payer: Ohio Health Group HMO |
$339.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$90.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$140.43
|
| Rate for Payer: PHCS Commercial |
$434.88
|
| Rate for Payer: United Healthcare All Payer |
$398.64
|
|
|
FAMILY THERAPY(P
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
900P0010
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$67.71 |
| Max. Negotiated Rate |
$161.69 |
| Rate for Payer: Aetna Commercial |
$161.69
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$67.71
|
| Rate for Payer: Anthem Medicaid |
$78.18
|
| Rate for Payer: Buckeye Medicare Advantage |
$153.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$142.98
|
| Rate for Payer: Healthspan PPO |
$130.54
|
| Rate for Payer: Humana Medicaid |
$78.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.47
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$79.74
|
| Rate for Payer: Molina Healthcare Passport |
$78.18
|
| Rate for Payer: Multiplan PHCS |
$91.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$107.10
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$78.96
|
|
|
FAMILY THERAPY(T
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 90847
|
| Hospital Charge Code |
900T0010
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$39.00 |
| 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 |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
