|
EYE LIGHT TREATMENT
|
Professional
|
Both
|
$338.00
|
|
| Hospital Charge Code |
22200784
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$236.60 |
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Multiplan PHCS |
$202.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.60
|
| Rate for Payer: UHCCP Medicaid |
$118.30
|
|
|
FACIAL BONES COMPLETE 3 VIEW(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
320P0012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$64.77 |
| Rate for Payer: Aetna Commercial |
$64.77
|
| Rate for Payer: Ambetter Exchange |
$42.08
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: Healthspan PPO |
$60.69
|
| Rate for Payer: Humana Medicaid |
$32.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.32
|
| Rate for Payer: Molina Healthcare Passport |
$32.67
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.70
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.08
|
|
|
FACIAL BONES COMPLETE 3 VIEWS
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.40 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$404.04
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
FACIAL BONES COMPLETE 3 VIEWS
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$497.28 |
| Rate for Payer: Aetna Commercial |
$398.86
|
| Rate for Payer: Anthem Medicaid |
$178.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$404.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$429.94
|
| Rate for Payer: First Health Commercial |
$492.10
|
| Rate for Payer: Humana Commercial |
$440.30
|
| Rate for Payer: Humana KY Medicaid |
$178.14
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$179.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$424.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$382.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$181.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$455.84
|
| Rate for Payer: Ohio Health Group HMO |
$388.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$357.42
|
| Rate for Payer: PHCS Commercial |
$497.28
|
| Rate for Payer: United Healthcare All Payer |
$455.84
|
|
|
FACIAL BONES COMPLETE 3 VIEWS
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
32000012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$310.80 |
| Rate for Payer: Aetna Commercial |
$64.77
|
| Rate for Payer: Ambetter Exchange |
$42.08
|
| Rate for Payer: Anthem Medicaid |
$32.67
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$63.85
|
| Rate for Payer: Healthspan PPO |
$60.69
|
| Rate for Payer: Humana Medicaid |
$32.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.38
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.32
|
| Rate for Payer: Molina Healthcare Passport |
$32.67
|
| Rate for Payer: Multiplan PHCS |
$310.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.70
|
| Rate for Payer: UHCCP Medicaid |
$181.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.08
|
|
|
FACIAL BONES COMPLETE 3 VIEW(T
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
320T0012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FACIAL BONES COMPLETE 3 VIEW(T
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
HCPCS 70150
|
| Hospital Charge Code |
320T0012
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$449.28 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Anthem Medicaid |
$160.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$388.44
|
| Rate for Payer: First Health Commercial |
$444.60
|
| Rate for Payer: Humana Commercial |
$397.80
|
| Rate for Payer: Humana KY Medicaid |
$160.95
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$162.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$383.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$345.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$411.84
|
| Rate for Payer: Ohio Health Group HMO |
$351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$322.92
|
| Rate for Payer: PHCS Commercial |
$449.28
|
| Rate for Payer: United Healthcare All Payer |
$411.84
|
|
|
FACIAL NERVE FUNCTION STUDY
|
Facility
|
OP
|
$692.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
76102451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$238.15 |
| Max. Negotiated Rate |
$664.80 |
| Rate for Payer: Aetna Commercial |
$533.23
|
| Rate for Payer: Anthem Medicaid |
$238.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cigna Commercial |
$574.77
|
| 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 |
$287.73
|
| 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 |
$345.28
|
| 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 |
$554.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.82
|
| Rate for Payer: PHCS Commercial |
$664.80
|
| Rate for Payer: United Healthcare All Payer |
$609.40
|
|
|
FACIAL NERVE FUNCTION STUDY
|
Facility
|
IP
|
$692.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
76102451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$207.75 |
| Max. Negotiated Rate |
$664.80 |
| Rate for Payer: Aetna Commercial |
$533.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$540.15
|
| Rate for Payer: Cash Price |
$346.25
|
| Rate for Payer: Cigna Commercial |
$574.77
|
| 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 |
$554.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$477.82
|
| 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 |
$19.69 |
| Max. Negotiated Rate |
$415.50 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Ambetter Exchange |
$21.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.69
|
| Rate for Payer: Anthem Medicaid |
$24.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.32
|
| 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 |
$24.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.53
|
| Rate for Payer: Molina Healthcare Passport |
$24.05
|
| Rate for Payer: Multiplan PHCS |
$415.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.43
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.10
|
|
|
FACIAL NERVE FUNCTION STUDY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
761P2451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$91.53 |
| Rate for Payer: Aetna Commercial |
$34.64
|
| Rate for Payer: Ambetter Exchange |
$21.10
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$19.69
|
| Rate for Payer: Anthem Medicaid |
$24.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$21.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$21.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$25.32
|
| 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 |
$24.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$21.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.53
|
| Rate for Payer: Molina Healthcare Passport |
$24.05
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$27.43
|
| Rate for Payer: UHCCP Medicaid |
$20.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.29
|
| Rate for Payer: Wellcare Medicare Advantage |
$21.10
|
|
|
FACIAL NERVE FUNCTION STUDY(T
|
Facility
|
IP
|
$542.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
761T2451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.75 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$417.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.15
|
| Rate for Payer: Cash Price |
$271.25
|
| Rate for Payer: Cigna Commercial |
$450.27
|
| 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 |
$400.37
|
| 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 |
$434.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.32
|
| Rate for Payer: PHCS Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Payer |
$477.40
|
|
|
FACIAL NERVE FUNCTION STUDY(T
|
Facility
|
OP
|
$542.50
|
|
|
Service Code
|
HCPCS 92516
|
| Hospital Charge Code |
761T2451
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.57 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$417.73
|
| Rate for Payer: Anthem Medicaid |
$186.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$423.15
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$271.25
|
| Rate for Payer: Cash Price |
$271.25
|
| Rate for Payer: Cigna Commercial |
$450.27
|
| 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 |
$287.73
|
| 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 |
$400.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| 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 |
$434.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$374.32
|
| 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 |
$66.60 |
| 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 |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.18
|
| 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 |
$133.20 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Ambetter Exchange |
$8.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.88
|
| Rate for Payer: Anthem Medicaid |
$16.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.86
|
| 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 |
$16.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.32
|
| Rate for Payer: Molina Healthcare Passport |
$16.98
|
| Rate for Payer: Multiplan PHCS |
$133.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.69
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.22
|
|
|
FACILITY CHARGE LEVEL
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000323
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.60 |
| 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 |
$177.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$193.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$153.18
|
| 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 |
$133.20 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Ambetter Exchange |
$8.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.88
|
| Rate for Payer: Anthem Medicaid |
$16.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.86
|
| 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 |
$16.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.32
|
| Rate for Payer: Molina Healthcare Passport |
$16.98
|
| Rate for Payer: Multiplan PHCS |
$133.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.69
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.22
|
|
|
FALLER STYLET F/COILED CATH
|
Facility
|
IP
|
$3,069.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$920.85 |
| Max. Negotiated Rate |
$2,946.72 |
| Rate for Payer: Aetna Commercial |
$2,363.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,394.21
|
| Rate for Payer: Cash Price |
$1,534.75
|
| Rate for Payer: Cigna Commercial |
$2,547.68
|
| Rate for Payer: First Health Commercial |
$2,916.03
|
| Rate for Payer: Humana Commercial |
$2,609.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,265.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,701.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,302.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,670.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.95
|
| Rate for Payer: PHCS Commercial |
$2,946.72
|
| Rate for Payer: United Healthcare All Payer |
$2,701.16
|
|
|
FALLER STYLET F/COILED CATH
|
Facility
|
OP
|
$3,069.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$920.85 |
| Max. Negotiated Rate |
$2,946.72 |
| Rate for Payer: Aetna Commercial |
$2,363.51
|
| Rate for Payer: Anthem Medicaid |
$1,055.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,394.21
|
| Rate for Payer: Cash Price |
$1,534.75
|
| Rate for Payer: Cigna Commercial |
$2,547.68
|
| Rate for Payer: First Health Commercial |
$2,916.03
|
| Rate for Payer: Humana Commercial |
$2,609.07
|
| Rate for Payer: Humana KY Medicaid |
$1,055.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,066.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,516.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,265.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$920.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,076.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,701.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,302.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,455.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,670.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,117.95
|
| Rate for Payer: PHCS Commercial |
$2,946.72
|
| Rate for Payer: United Healthcare All Payer |
$2,701.16
|
|
|
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 |
$148.46 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$355.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$364.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$314.64
|
| Rate for Payer: PHCS Commercial |
$437.76
|
| Rate for Payer: United Healthcare All Payer |
$401.28
|
|
|
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 |
$273.60 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Ambetter Exchange |
$97.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.66
|
| Rate for Payer: Anthem Medicaid |
$76.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.87
|
| 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 |
$76.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.71
|
| Rate for Payer: Molina Healthcare Passport |
$76.19
|
| Rate for Payer: Multiplan PHCS |
$273.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.61
|
| Rate for Payer: UHCCP Medicaid |
$60.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.39
|
|
|
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 |
$136.80 |
| 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 |
$364.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$396.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$314.64
|
| 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 |
$134.75 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Ambetter Exchange |
$97.39
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$57.66
|
| Rate for Payer: Anthem Medicaid |
$76.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$97.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$97.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$116.87
|
| 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 |
$76.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$97.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.71
|
| Rate for Payer: Molina Healthcare Passport |
$76.19
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.61
|
| Rate for Payer: UHCCP Medicaid |
$60.54
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$97.39
|
|
|
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 |
$76.80 |
| 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 |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| 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
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS 90846
|
| Hospital Charge Code |
900T0009
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$88.04 |
| 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 |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| 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 |
$148.46
|
| 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 |
$178.15
|
| 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 |
$204.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$176.64
|
| Rate for Payer: PHCS Commercial |
$245.76
|
| Rate for Payer: United Healthcare All Payer |
$225.28
|
|
