|
NEW PT HIGH LEVEL 5
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$486.60 |
| Rate for Payer: Aetna Commercial |
$235.26
|
| Rate for Payer: Ambetter Exchange |
$171.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.75
|
| Rate for Payer: Anthem Medicaid |
$143.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.72
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$266.06
|
| Rate for Payer: Healthspan PPO |
$208.70
|
| Rate for Payer: Humana Medicaid |
$143.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Passport |
$143.29
|
| Rate for Payer: Multiplan PHCS |
$486.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.86
|
| Rate for Payer: UHCCP Medicaid |
$97.39
|
| Rate for Payer: United Healthcare Non-Options |
$162.03
|
| Rate for Payer: United Healthcare Options |
$132.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.43
|
|
|
NEW PT HIGH LEVEL 5
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.59
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
NEW PT HIGH LEVEL 5
|
Facility
|
IP
|
$811.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.59
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
NEW PT HIGH LEVEL 5
|
Facility
|
OP
|
$811.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
51000005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$243.30 |
| Max. Negotiated Rate |
$778.56 |
| Rate for Payer: Aetna Commercial |
$624.47
|
| Rate for Payer: Anthem Medicaid |
$278.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.58
|
| Rate for Payer: Cash Price |
$405.50
|
| Rate for Payer: Cigna Commercial |
$673.13
|
| Rate for Payer: First Health Commercial |
$770.45
|
| Rate for Payer: Humana Commercial |
$689.35
|
| Rate for Payer: Humana KY Medicaid |
$278.90
|
| Rate for Payer: Kentucky WC Medicaid |
$281.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$713.68
|
| Rate for Payer: Ohio Health Group HMO |
$608.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$648.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$705.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$559.59
|
| Rate for Payer: PHCS Commercial |
$778.56
|
| Rate for Payer: United Healthcare All Payer |
$713.68
|
|
|
NEW PT HIGH LEVEL 5(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
510P0005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$266.06 |
| Rate for Payer: Aetna Commercial |
$235.26
|
| Rate for Payer: Ambetter Exchange |
$171.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.75
|
| Rate for Payer: Anthem Medicaid |
$143.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.72
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$266.06
|
| Rate for Payer: Healthspan PPO |
$208.70
|
| Rate for Payer: Humana Medicaid |
$143.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Passport |
$143.29
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.86
|
| Rate for Payer: UHCCP Medicaid |
$97.39
|
| Rate for Payer: United Healthcare Non-Options |
$162.03
|
| Rate for Payer: United Healthcare Options |
$132.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.43
|
|
|
NEW PT HIGH LEVEL 5(T
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.59
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
NEW PT HIGH LEVEL 5(T
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
510T0005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem Medicaid |
$175.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Humana KY Medicaid |
$175.73
|
| Rate for Payer: Kentucky WC Medicaid |
$177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.59
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
NEW PT HIGH LEVEL 5(T
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
510T0005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$153.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.59
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
NEW PT HIGH LEVEL 5(T
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0005
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$490.56 |
| Rate for Payer: Aetna Commercial |
$393.47
|
| Rate for Payer: Anthem Medicaid |
$175.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$398.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cash Price |
$255.50
|
| Rate for Payer: Cigna Commercial |
$424.13
|
| Rate for Payer: First Health Commercial |
$485.45
|
| Rate for Payer: Humana Commercial |
$434.35
|
| Rate for Payer: Humana KY Medicaid |
$175.73
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$177.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$419.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$377.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$179.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$449.68
|
| Rate for Payer: Ohio Health Group HMO |
$383.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.59
|
| Rate for Payer: PHCS Commercial |
$490.56
|
| Rate for Payer: United Healthcare All Payer |
$449.68
|
|
|
NEW PT HIGH LEVEL 5 TELEHEALTH
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 99205
|
| Hospital Charge Code |
51000285
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Aetna Commercial |
$235.26
|
| Rate for Payer: Ambetter Exchange |
$171.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$92.75
|
| Rate for Payer: Anthem Medicaid |
$143.29
|
| Rate for Payer: Buckeye Individual/Medicaid |
$171.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$171.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$205.72
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cash Price |
$372.50
|
| Rate for Payer: Cigna Commercial |
$266.06
|
| Rate for Payer: Healthspan PPO |
$208.70
|
| Rate for Payer: Humana Medicaid |
$143.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$171.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$146.16
|
| Rate for Payer: Molina Healthcare Passport |
$143.29
|
| Rate for Payer: Multiplan PHCS |
$447.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$222.86
|
| Rate for Payer: UHCCP Medicaid |
$97.39
|
| Rate for Payer: United Healthcare Non-Options |
$162.03
|
| Rate for Payer: United Healthcare Options |
$132.63
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$144.72
|
| Rate for Payer: Wellcare Medicare Advantage |
$171.43
|
|
|
NEW PT LOW LEVEL 2
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
51000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem Medicaid |
$148.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Humana KY Medicaid |
$148.22
|
| Rate for Payer: Kentucky WC Medicaid |
$149.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
NEW PT LOW LEVEL 2
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
NEW PT LOW LEVEL 2
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem Medicaid |
$148.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Humana KY Medicaid |
$148.22
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$149.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
NEW PT LOW LEVEL 2
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
51000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$413.76 |
| Rate for Payer: Aetna Commercial |
$331.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$336.18
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$357.73
|
| Rate for Payer: First Health Commercial |
$409.45
|
| Rate for Payer: Humana Commercial |
$366.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$353.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$318.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$379.28
|
| Rate for Payer: Ohio Health Group HMO |
$323.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$374.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.39
|
| Rate for Payer: PHCS Commercial |
$413.76
|
| Rate for Payer: United Healthcare All Payer |
$379.28
|
|
|
NEW PT LOW LEVEL 2
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
51000002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$258.60 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Ambetter Exchange |
$44.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.75
|
| Rate for Payer: Anthem Medicaid |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.05
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cash Price |
$215.50
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Healthspan PPO |
$73.43
|
| Rate for Payer: Humana Medicaid |
$53.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.06
|
| Rate for Payer: Molina Healthcare Passport |
$53.00
|
| Rate for Payer: Multiplan PHCS |
$258.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.47
|
| Rate for Payer: UHCCP Medicaid |
$25.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.21
|
|
|
NEW PT LOW LEVEL 2(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
510P0002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Ambetter Exchange |
$44.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.75
|
| Rate for Payer: Anthem Medicaid |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.05
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Healthspan PPO |
$73.43
|
| Rate for Payer: Humana Medicaid |
$53.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.06
|
| Rate for Payer: Molina Healthcare Passport |
$53.00
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.47
|
| Rate for Payer: UHCCP Medicaid |
$25.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.21
|
|
|
NEW PT LOW LEVEL 2(T
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$269.76 |
| Rate for Payer: Aetna Commercial |
$216.37
|
| Rate for Payer: Anthem Medicaid |
$96.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$140.50
|
| Rate for Payer: Cash Price |
$140.50
|
| Rate for Payer: Cigna Commercial |
$233.23
|
| Rate for Payer: First Health Commercial |
$266.95
|
| Rate for Payer: Humana Commercial |
$238.85
|
| Rate for Payer: Humana KY Medicaid |
$96.64
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$97.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$230.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$207.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$247.28
|
| Rate for Payer: Ohio Health Group HMO |
$210.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.89
|
| Rate for Payer: PHCS Commercial |
$269.76
|
| Rate for Payer: United Healthcare All Payer |
$247.28
|
|
|
NEW PT LOW LEVEL 2(T
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
510T0002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.30 |
| Max. Negotiated Rate |
$269.76 |
| Rate for Payer: Aetna Commercial |
$216.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.18
|
| Rate for Payer: Cash Price |
$140.50
|
| Rate for Payer: Cigna Commercial |
$233.23
|
| Rate for Payer: First Health Commercial |
$266.95
|
| Rate for Payer: Humana Commercial |
$238.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$230.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$207.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$247.28
|
| Rate for Payer: Ohio Health Group HMO |
$210.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.89
|
| Rate for Payer: PHCS Commercial |
$269.76
|
| Rate for Payer: United Healthcare All Payer |
$247.28
|
|
|
NEW PT LOW LEVEL 2(T
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.30 |
| Max. Negotiated Rate |
$269.76 |
| Rate for Payer: Aetna Commercial |
$216.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.18
|
| Rate for Payer: Cash Price |
$140.50
|
| Rate for Payer: Cigna Commercial |
$233.23
|
| Rate for Payer: First Health Commercial |
$266.95
|
| Rate for Payer: Humana Commercial |
$238.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$230.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$207.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$247.28
|
| Rate for Payer: Ohio Health Group HMO |
$210.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.89
|
| Rate for Payer: PHCS Commercial |
$269.76
|
| Rate for Payer: United Healthcare All Payer |
$247.28
|
|
|
NEW PT LOW LEVEL 2(T
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
510T0002
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.30 |
| Max. Negotiated Rate |
$269.76 |
| Rate for Payer: Aetna Commercial |
$216.37
|
| Rate for Payer: Anthem Medicaid |
$96.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$219.18
|
| Rate for Payer: Cash Price |
$140.50
|
| Rate for Payer: Cigna Commercial |
$233.23
|
| Rate for Payer: First Health Commercial |
$266.95
|
| Rate for Payer: Humana Commercial |
$238.85
|
| Rate for Payer: Humana KY Medicaid |
$96.64
|
| Rate for Payer: Kentucky WC Medicaid |
$97.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$230.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$207.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$247.28
|
| Rate for Payer: Ohio Health Group HMO |
$210.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.89
|
| Rate for Payer: PHCS Commercial |
$269.76
|
| Rate for Payer: United Healthcare All Payer |
$247.28
|
|
|
NEW PT LOW LEVEL 2 TELEHEALTH
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 99202
|
| Hospital Charge Code |
51000161
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$71.49
|
| Rate for Payer: Ambetter Exchange |
$44.21
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$24.75
|
| Rate for Payer: Anthem Medicaid |
$53.00
|
| Rate for Payer: Buckeye Individual/Medicaid |
$44.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$44.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$53.05
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cash Price |
$197.50
|
| Rate for Payer: Cigna Commercial |
$93.60
|
| Rate for Payer: Healthspan PPO |
$73.43
|
| Rate for Payer: Humana Medicaid |
$53.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$66.50
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$44.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$44.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$54.06
|
| Rate for Payer: Molina Healthcare Passport |
$53.00
|
| Rate for Payer: Multiplan PHCS |
$237.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$57.47
|
| Rate for Payer: UHCCP Medicaid |
$25.99
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$53.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$44.21
|
|
|
NEW PT LOW LEVEL 3 TELEHEALTH
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
51000179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$27,517.35 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Ambetter Exchange |
$77.43
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.22
|
| Rate for Payer: Anthem Medicaid |
$79.04
|
| Rate for Payer: Buckeye Individual/Medicaid |
$77.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$77.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$92.92
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$138.86
|
| Rate for Payer: Healthspan PPO |
$106.83
|
| Rate for Payer: Humana Medicaid |
$79.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$77.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$80.62
|
| Rate for Payer: Molina Healthcare Passport |
$79.04
|
| Rate for Payer: Multiplan PHCS |
$270.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$100.66
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: United Healthcare Non-Options |
$27,517.35
|
| Rate for Payer: United Healthcare Options |
$61.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$79.83
|
| Rate for Payer: Wellcare Medicare Advantage |
$77.43
|
|
|
NEW PT MID LEVEL 3
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 99203
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Anthem Medicaid |
$169.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.54
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$409.19
|
| Rate for Payer: First Health Commercial |
$468.35
|
| Rate for Payer: Humana Commercial |
$419.05
|
| Rate for Payer: Humana KY Medicaid |
$169.54
|
| Rate for Payer: Kentucky WC Medicaid |
$171.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.84
|
| Rate for Payer: Ohio Health Group HMO |
$369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.17
|
| Rate for Payer: PHCS Commercial |
$473.28
|
| Rate for Payer: United Healthcare All Payer |
$433.84
|
|
|
NEW PT MID LEVEL 3
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Anthem Medicaid |
$169.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$409.19
|
| Rate for Payer: First Health Commercial |
$468.35
|
| Rate for Payer: Humana Commercial |
$419.05
|
| Rate for Payer: Humana KY Medicaid |
$169.54
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$171.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.84
|
| Rate for Payer: Ohio Health Group HMO |
$369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.17
|
| Rate for Payer: PHCS Commercial |
$473.28
|
| Rate for Payer: United Healthcare All Payer |
$433.84
|
|
|
NEW PT MID LEVEL 3
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.54
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$409.19
|
| Rate for Payer: First Health Commercial |
$468.35
|
| Rate for Payer: Humana Commercial |
$419.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.84
|
| Rate for Payer: Ohio Health Group HMO |
$369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.17
|
| Rate for Payer: PHCS Commercial |
$473.28
|
| Rate for Payer: United Healthcare All Payer |
$433.84
|
|
