|
HOME VISIT EST PT MOD-HI 40MIN
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
HOME VISIT EST PT MOD-HI 40MIN
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
HOME VISIT EST PT MOD-HI 40M(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
510P0086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$182.67 |
| Rate for Payer: Aetna Commercial |
$182.67
|
| Rate for Payer: Anthem Medicaid |
$115.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$156.09
|
| Rate for Payer: Healthspan PPO |
$141.50
|
| Rate for Payer: Humana Medicaid |
$115.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$166.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$118.08
|
| Rate for Payer: Molina Healthcare Passport |
$115.76
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.92
|
|
|
HOME VISIT NEW PT HI 60MIN
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
HCPCS 99344
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
HOME VISIT NEW PT HI 60MIN
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99344
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Anthem Medicaid |
$171.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$203.10
|
| Rate for Payer: Humana Medicaid |
$171.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.03
|
| Rate for Payer: Molina Healthcare Passport |
$171.60
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.32
|
|
|
HOME VISIT NEW PT HI 60MIN
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 99344
|
| Hospital Charge Code |
51000082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.50 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$85.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$195.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$85.98
|
| Rate for Payer: Kentucky WC Medicaid |
$86.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$87.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$50.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$77.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
|
HOME VISIT NEW PT HI 60MIN(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99344
|
| Hospital Charge Code |
510P0082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Anthem Medicaid |
$171.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$203.10
|
| Rate for Payer: Humana Medicaid |
$171.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$238.34
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.03
|
| Rate for Payer: Molina Healthcare Passport |
$171.60
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.32
|
|
|
HOME VISIT NEW PT UNSTAB 75MIN
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
HCPCS 99345
|
| Hospital Charge Code |
51000083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
HOME VISIT NEW PT UNSTAB 75MIN
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
HCPCS 99345
|
| Hospital Charge Code |
51000083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.50 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$423.50
|
| Rate for Payer: Anthem Medicaid |
$189.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$429.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$456.50
|
| Rate for Payer: First Health Commercial |
$522.50
|
| Rate for Payer: Humana Commercial |
$467.50
|
| Rate for Payer: Humana KY Medicaid |
$189.14
|
| Rate for Payer: Kentucky WC Medicaid |
$191.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$451.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$405.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$192.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$484.00
|
| Rate for Payer: Ohio Health Group HMO |
$412.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$170.50
|
| Rate for Payer: PHCS Commercial |
$528.00
|
| Rate for Payer: United Healthcare All Payer |
$484.00
|
|
|
HOME VISIT NEW PT UNSTAB 75MIN
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 99345
|
| Hospital Charge Code |
51000083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$315.49
|
| Rate for Payer: Anthem Medicaid |
$203.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$284.25
|
| Rate for Payer: Healthspan PPO |
$244.38
|
| Rate for Payer: Humana Medicaid |
$203.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$286.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.87
|
| Rate for Payer: Molina Healthcare Passport |
$203.79
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.83
|
|
|
HOME VISIT NEW PT UNSTAB 75M(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 99345
|
| Hospital Charge Code |
510P0083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$550.00 |
| Rate for Payer: Aetna Commercial |
$315.49
|
| Rate for Payer: Anthem Medicaid |
$203.79
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$284.25
|
| Rate for Payer: Healthspan PPO |
$244.38
|
| Rate for Payer: Humana Medicaid |
$203.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$286.20
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$207.87
|
| Rate for Payer: Molina Healthcare Passport |
$203.79
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$205.83
|
|
|
HOME VIS NEW PT MOD 30MIN
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
HCPCS 99342
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem Medicaid |
$94.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Humana KY Medicaid |
$94.57
|
| Rate for Payer: Kentucky WC Medicaid |
$95.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$96.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
HOME VIS NEW PT MOD 30MIN
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 99342
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$124.32
|
| Rate for Payer: Anthem Medicaid |
$98.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$121.24
|
| Rate for Payer: Healthspan PPO |
$96.30
|
| Rate for Payer: Humana Medicaid |
$98.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.01
|
| Rate for Payer: Molina Healthcare Passport |
$98.05
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.03
|
|
|
HOME VIS NEW PT MOD 30MIN
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
HCPCS 99342
|
| Hospital Charge Code |
51000080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.75 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$211.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$214.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$228.25
|
| Rate for Payer: First Health Commercial |
$261.25
|
| Rate for Payer: Humana Commercial |
$233.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$225.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$202.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.00
|
| Rate for Payer: Ohio Health Group HMO |
$206.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$35.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$85.25
|
| Rate for Payer: PHCS Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Payer |
$242.00
|
|
|
HOME VIS NEW PT MOD 30MIN(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 99342
|
| Hospital Charge Code |
510P0080
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Aetna Commercial |
$124.32
|
| Rate for Payer: Anthem Medicaid |
$98.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$121.24
|
| Rate for Payer: Healthspan PPO |
$96.30
|
| Rate for Payer: Humana Medicaid |
$98.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.79
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.01
|
| Rate for Payer: Molina Healthcare Passport |
$98.05
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.03
|
|
|
HOME VST EST PT UNSTAB 60MIN
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 99350
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HOME VST EST PT UNSTAB 60MIN
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 99350
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$183.30
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
HOME VST EST PT UNSTAB 60MIN
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 99350
|
| Hospital Charge Code |
51000087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$254.82 |
| Rate for Payer: Aetna Commercial |
$254.82
|
| Rate for Payer: Anthem Medicaid |
$167.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$197.38
|
| Rate for Payer: Humana Medicaid |
$167.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.62
|
| Rate for Payer: Molina Healthcare Passport |
$167.27
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.94
|
|
|
HOME VST EST PT UNSTAB 60MIN(P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 99350
|
| Hospital Charge Code |
510P0087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$254.82 |
| Rate for Payer: Aetna Commercial |
$254.82
|
| Rate for Payer: Anthem Medicaid |
$167.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$230.30
|
| Rate for Payer: Healthspan PPO |
$197.38
|
| Rate for Payer: Humana Medicaid |
$167.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$231.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$170.62
|
| Rate for Payer: Molina Healthcare Passport |
$167.27
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$168.94
|
|
|
HOMOCYSTEINE
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30000368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.24
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
HOMOCYSTEINE
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS 83090
|
| Hospital Charge Code |
30000368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$195.84 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Anthem Medicaid |
$17.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$17.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$163.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$25.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$17.92
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$169.32
|
| Rate for Payer: First Health Commercial |
$193.80
|
| Rate for Payer: Humana Commercial |
$173.40
|
| Rate for Payer: Humana KY Medicaid |
$17.92
|
| Rate for Payer: Humana Medicare Advantage |
$17.92
|
| Rate for Payer: Kentucky WC Medicaid |
$18.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$167.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$150.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$179.52
|
| Rate for Payer: Ohio Health Group HMO |
$153.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$40.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.24
|
| Rate for Payer: PHCS Commercial |
$195.84
|
| Rate for Payer: United Healthcare All Payer |
$179.52
|
|
|
HOSP DISCH D MAN 30 MIN OR LES
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.44 |
| Max. Negotiated Rate |
$518.00 |
| Rate for Payer: Aetna Commercial |
$104.76
|
| Rate for Payer: Anthem Medicaid |
$53.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$518.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cash Price |
$259.00
|
| Rate for Payer: Cigna Commercial |
$99.96
|
| Rate for Payer: Healthspan PPO |
$77.87
|
| Rate for Payer: Humana Medicaid |
$53.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.51
|
| Rate for Payer: Molina Healthcare Passport |
$53.44
|
| Rate for Payer: Multiplan PHCS |
$310.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$362.60
|
| Rate for Payer: UHCCP Medicaid |
$181.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.97
|
|
|
HOSP DISCH D MAN 30 MIN OR LES
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
510P0017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$104.76
|
| Rate for Payer: Anthem Medicaid |
$53.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$99.96
|
| Rate for Payer: Healthspan PPO |
$77.87
|
| Rate for Payer: Humana Medicaid |
$53.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$94.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.51
|
| Rate for Payer: Molina Healthcare Passport |
$53.44
|
| Rate for Payer: Multiplan PHCS |
$81.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$94.50
|
| Rate for Payer: UHCCP Medicaid |
$47.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.97
|
|
|
HOSP DISCH D MAN> 30 MINUTES
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$152.14
|
| Rate for Payer: Anthem Medicaid |
$72.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.64
|
| Rate for Payer: Healthspan PPO |
$113.10
|
| Rate for Payer: Humana Medicaid |
$72.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.35
|
| Rate for Payer: Molina Healthcare Passport |
$72.89
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.62
|
|
|
HOSP DISCH D MAN> 30 MINUTES(P
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
510P0018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$152.14
|
| Rate for Payer: Anthem Medicaid |
$72.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$180.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$144.64
|
| Rate for Payer: Healthspan PPO |
$113.10
|
| Rate for Payer: Humana Medicaid |
$72.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$138.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$74.35
|
| Rate for Payer: Molina Healthcare Passport |
$72.89
|
| Rate for Payer: Multiplan PHCS |
$108.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$126.00
|
| Rate for Payer: UHCCP Medicaid |
$63.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.62
|
|
