|
HOME/RES VST NEW SF MDM 15
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99341
|
| Hospital Charge Code |
51000337
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna Commercial |
$85.42
|
| Rate for Payer: Ambetter Exchange |
$46.35
|
| Rate for Payer: Anthem Medicaid |
$74.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.62
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$82.47
|
| Rate for Payer: Healthspan PPO |
$66.17
|
| Rate for Payer: Humana Medicaid |
$74.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.87
|
| Rate for Payer: Molina Healthcare Passport |
$74.38
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.26
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.35
|
|
|
HOME/RES VST NEW SF MDM 15(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99341
|
| Hospital Charge Code |
510P0337
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$85.42 |
| Rate for Payer: Aetna Commercial |
$85.42
|
| Rate for Payer: Ambetter Exchange |
$46.35
|
| Rate for Payer: Anthem Medicaid |
$74.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$46.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$46.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$55.62
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$82.47
|
| Rate for Payer: Healthspan PPO |
$66.17
|
| Rate for Payer: Humana Medicaid |
$74.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$46.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.87
|
| Rate for Payer: Molina Healthcare Passport |
$74.38
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$60.26
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.12
|
| Rate for Payer: Wellcare Medicare Advantage |
$46.35
|
|
|
HOME SLEEP STUDY
|
Facility
|
IP
|
$2,014.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
92000013
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$604.20 |
| Max. Negotiated Rate |
$1,933.44 |
| Rate for Payer: Aetna Commercial |
$1,550.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,570.92
|
| Rate for Payer: Cash Price |
$1,007.00
|
| Rate for Payer: Cigna Commercial |
$1,671.62
|
| Rate for Payer: First Health Commercial |
$1,913.30
|
| Rate for Payer: Humana Commercial |
$1,711.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.66
|
| Rate for Payer: PHCS Commercial |
$1,933.44
|
| Rate for Payer: United Healthcare All Payer |
$1,772.32
|
|
|
HOME SLEEP STUDY
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$310.10 |
| Rate for Payer: Aetna Commercial |
$240.12
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$39.71
|
| Rate for Payer: Multiplan PHCS |
$265.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$310.10
|
| Rate for Payer: UHCCP Medicaid |
$155.05
|
|
|
HOME SLEEP STUDY
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$132.90 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$385.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.67
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
HOME SLEEP STUDY
|
Facility
|
OP
|
$2,014.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
92000013
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$1,933.44 |
| Rate for Payer: Aetna Commercial |
$1,550.78
|
| Rate for Payer: Anthem Medicaid |
$692.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,570.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$1,007.00
|
| Rate for Payer: Cash Price |
$1,007.00
|
| Rate for Payer: Cigna Commercial |
$1,671.62
|
| Rate for Payer: First Health Commercial |
$1,913.30
|
| Rate for Payer: Humana Commercial |
$1,711.90
|
| Rate for Payer: Humana KY Medicaid |
$692.61
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,651.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,486.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,772.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,510.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,611.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,752.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.66
|
| Rate for Payer: PHCS Commercial |
$1,933.44
|
| Rate for Payer: United Healthcare All Payer |
$1,772.32
|
|
|
HOME SLEEP STUDY
|
Professional
|
Both
|
$2,014.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
92000013
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$1,208.40 |
| Rate for Payer: Aetna Commercial |
$324.29
|
| Rate for Payer: Ambetter Exchange |
$87.74
|
| Rate for Payer: Anthem Medicaid |
$246.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.29
|
| Rate for Payer: Cash Price |
$1,007.00
|
| Rate for Payer: Cash Price |
$1,007.00
|
| Rate for Payer: Cigna Commercial |
$308.71
|
| Rate for Payer: Healthspan PPO |
$283.61
|
| Rate for Payer: Humana Medicaid |
$246.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.57
|
| Rate for Payer: Molina Healthcare Passport |
$246.64
|
| Rate for Payer: Multiplan PHCS |
$1,208.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.06
|
| Rate for Payer: UHCCP Medicaid |
$704.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.74
|
|
|
HOME SLEEP STUDY
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
92000014
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$425.28 |
| Rate for Payer: Aetna Commercial |
$341.11
|
| Rate for Payer: Anthem Medicaid |
$152.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cash Price |
$221.50
|
| Rate for Payer: Cigna Commercial |
$367.69
|
| Rate for Payer: First Health Commercial |
$420.85
|
| Rate for Payer: Humana Commercial |
$376.55
|
| Rate for Payer: Humana KY Medicaid |
$152.35
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$153.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$363.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.84
|
| Rate for Payer: Ohio Health Group HMO |
$332.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$385.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$305.67
|
| Rate for Payer: PHCS Commercial |
$425.28
|
| Rate for Payer: United Healthcare All Payer |
$389.84
|
|
|
HOME SLEEP STUDY(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
920P0013
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$324.29 |
| Rate for Payer: Aetna Commercial |
$324.29
|
| Rate for Payer: Ambetter Exchange |
$87.74
|
| Rate for Payer: Anthem Medicaid |
$246.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.29
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$308.71
|
| Rate for Payer: Healthspan PPO |
$283.61
|
| Rate for Payer: Humana Medicaid |
$246.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$75.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.57
|
| Rate for Payer: Molina Healthcare Passport |
$246.64
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.06
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$249.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.74
|
|
|
HOME SLEEP STUDY(T
|
Facility
|
OP
|
$1,789.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
920T0013
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$1,717.44 |
| Rate for Payer: Aetna Commercial |
$1,377.53
|
| Rate for Payer: Anthem Medicaid |
$615.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,395.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$894.50
|
| Rate for Payer: Cash Price |
$894.50
|
| Rate for Payer: Cigna Commercial |
$1,484.87
|
| Rate for Payer: First Health Commercial |
$1,699.55
|
| Rate for Payer: Humana Commercial |
$1,520.65
|
| Rate for Payer: Humana KY Medicaid |
$615.24
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$621.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,320.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,574.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.41
|
| Rate for Payer: PHCS Commercial |
$1,717.44
|
| Rate for Payer: United Healthcare All Payer |
$1,574.32
|
|
|
HOME SLEEP STUDY(T
|
Facility
|
IP
|
$1,789.00
|
|
|
Service Code
|
HCPCS 95806
|
| Hospital Charge Code |
920T0013
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$536.70 |
| Max. Negotiated Rate |
$1,717.44 |
| Rate for Payer: Aetna Commercial |
$1,377.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,395.42
|
| Rate for Payer: Cash Price |
$894.50
|
| Rate for Payer: Cigna Commercial |
$1,484.87
|
| Rate for Payer: First Health Commercial |
$1,699.55
|
| Rate for Payer: Humana Commercial |
$1,520.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,320.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,574.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,431.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,234.41
|
| Rate for Payer: PHCS Commercial |
$1,717.44
|
| Rate for Payer: United Healthcare All Payer |
$1,574.32
|
|
|
HOME VISIT/30 MINUTES
|
Facility
|
IP
|
$273.50
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$262.56 |
| Rate for Payer: Aetna Commercial |
$210.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.33
|
| Rate for Payer: Cash Price |
$136.75
|
| Rate for Payer: Cigna Commercial |
$227.00
|
| Rate for Payer: First Health Commercial |
$259.82
|
| Rate for Payer: Humana Commercial |
$232.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.68
|
| Rate for Payer: Ohio Health Group HMO |
$205.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.72
|
| Rate for Payer: PHCS Commercial |
$262.56
|
| Rate for Payer: United Healthcare All Payer |
$240.68
|
|
|
HOME VISIT/30 MINUTES
|
Professional
|
Both
|
$273.50
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$164.10 |
| Rate for Payer: Aetna Commercial |
$125.38
|
| Rate for Payer: Ambetter Exchange |
$72.11
|
| Rate for Payer: Anthem Medicaid |
$78.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.53
|
| Rate for Payer: Cash Price |
$136.75
|
| Rate for Payer: Cash Price |
$136.75
|
| Rate for Payer: Cigna Commercial |
$100.99
|
| Rate for Payer: Healthspan PPO |
$97.12
|
| Rate for Payer: Humana Medicaid |
$78.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.05
|
| Rate for Payer: Molina Healthcare Passport |
$78.48
|
| Rate for Payer: Multiplan PHCS |
$164.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.74
|
| Rate for Payer: UHCCP Medicaid |
$95.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.11
|
|
|
HOME VISIT/30 MINUTES
|
Facility
|
OP
|
$273.50
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
51000085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$262.56 |
| Rate for Payer: Aetna Commercial |
$210.59
|
| Rate for Payer: Anthem Medicaid |
$94.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$213.33
|
| Rate for Payer: Cash Price |
$136.75
|
| Rate for Payer: Cigna Commercial |
$227.00
|
| Rate for Payer: First Health Commercial |
$259.82
|
| Rate for Payer: Humana Commercial |
$232.47
|
| Rate for Payer: Humana KY Medicaid |
$94.06
|
| Rate for Payer: Kentucky WC Medicaid |
$95.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$224.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$201.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$95.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$240.68
|
| Rate for Payer: Ohio Health Group HMO |
$205.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$188.72
|
| Rate for Payer: PHCS Commercial |
$262.56
|
| Rate for Payer: United Healthcare All Payer |
$240.68
|
|
|
HOME VISIT/30 MINUTES(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
510P0085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$125.38 |
| Rate for Payer: Aetna Commercial |
$125.38
|
| Rate for Payer: Ambetter Exchange |
$72.11
|
| Rate for Payer: Anthem Medicaid |
$78.48
|
| Rate for Payer: Buckeye Individual/Medicaid |
$72.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$72.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.53
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$100.99
|
| Rate for Payer: Healthspan PPO |
$97.12
|
| Rate for Payer: Humana Medicaid |
$78.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$112.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$72.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.05
|
| Rate for Payer: Molina Healthcare Passport |
$78.48
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.74
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.26
|
| Rate for Payer: Wellcare Medicare Advantage |
$72.11
|
|
|
HOME VISIT/30 MINUTES(T
|
Facility
|
OP
|
$153.50
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
510T0085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$147.36 |
| Rate for Payer: Aetna Commercial |
$118.19
|
| Rate for Payer: Anthem Medicaid |
$52.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.73
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Cigna Commercial |
$127.41
|
| Rate for Payer: First Health Commercial |
$145.82
|
| Rate for Payer: Humana Commercial |
$130.47
|
| Rate for Payer: Humana KY Medicaid |
$52.79
|
| Rate for Payer: Kentucky WC Medicaid |
$53.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$53.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.08
|
| Rate for Payer: Ohio Health Group HMO |
$115.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.92
|
| Rate for Payer: PHCS Commercial |
$147.36
|
| Rate for Payer: United Healthcare All Payer |
$135.08
|
|
|
HOME VISIT/30 MINUTES(T
|
Facility
|
IP
|
$153.50
|
|
|
Service Code
|
HCPCS 99348
|
| Hospital Charge Code |
510T0085
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.05 |
| Max. Negotiated Rate |
$147.36 |
| Rate for Payer: Aetna Commercial |
$118.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$119.73
|
| Rate for Payer: Cash Price |
$76.75
|
| Rate for Payer: Cigna Commercial |
$127.41
|
| Rate for Payer: First Health Commercial |
$145.82
|
| Rate for Payer: Humana Commercial |
$130.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$113.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$135.08
|
| Rate for Payer: Ohio Health Group HMO |
$115.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.92
|
| Rate for Payer: PHCS Commercial |
$147.36
|
| Rate for Payer: United Healthcare All Payer |
$135.08
|
|
|
HOME VISIT BRIEF
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 99347
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
HOME VISIT BRIEF
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99347
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$83.07 |
| Rate for Payer: Aetna Commercial |
$83.07
|
| Rate for Payer: Ambetter Exchange |
$42.53
|
| Rate for Payer: Anthem Medicaid |
$53.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.04
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: Healthspan PPO |
$64.34
|
| Rate for Payer: Humana Medicaid |
$53.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.17
|
| Rate for Payer: Molina Healthcare Passport |
$53.11
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.29
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.53
|
|
|
HOME VISIT BRIEF
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 99347
|
| Hospital Charge Code |
51000084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
HOME VISIT BRIEF(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99347
|
| Hospital Charge Code |
510P0084
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$83.07 |
| Rate for Payer: Aetna Commercial |
$83.07
|
| Rate for Payer: Ambetter Exchange |
$42.53
|
| Rate for Payer: Anthem Medicaid |
$53.11
|
| Rate for Payer: Buckeye Individual/Medicaid |
$42.53
|
| Rate for Payer: Buckeye Medicare Advantage |
$42.53
|
| Rate for Payer: CareSource Just4Me Medicare |
$51.04
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$63.91
|
| Rate for Payer: Healthspan PPO |
$64.34
|
| Rate for Payer: Humana Medicaid |
$53.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$42.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.17
|
| Rate for Payer: Molina Healthcare Passport |
$53.11
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$55.29
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$42.53
|
|
|
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 |
$52.50 |
| 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 |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
HOME VISIT EST PT MOD-HI 40MIN
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99349
|
| Hospital Charge Code |
51000086
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$182.67 |
| Rate for Payer: Aetna Commercial |
$182.67
|
| Rate for Payer: Ambetter Exchange |
$119.34
|
| Rate for Payer: Anthem Medicaid |
$115.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$119.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.34
|
| 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 |
$155.14
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.34
|
|
|
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 |
$52.50 |
| 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 |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| 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: Ambetter Exchange |
$119.34
|
| Rate for Payer: Anthem Medicaid |
$115.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$119.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$119.34
|
| Rate for Payer: CareSource Just4Me Medicare |
$143.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$119.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$119.34
|
| 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 |
$155.14
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.92
|
| Rate for Payer: Wellcare Medicare Advantage |
$119.34
|
|
