|
NURSING FACILITY CARE INITIA(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
510P0062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$227.24 |
| Rate for Payer: Aetna Commercial |
$227.24
|
| Rate for Payer: Ambetter Exchange |
$170.66
|
| Rate for Payer: Anthem Medicaid |
$130.50
|
| Rate for Payer: Buckeye Individual/Medicaid |
$170.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$170.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$204.79
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$152.21
|
| Rate for Payer: Healthspan PPO |
$168.92
|
| Rate for Payer: Humana Medicaid |
$130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$215.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$170.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$170.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$133.11
|
| Rate for Payer: Molina Healthcare Passport |
$130.50
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$221.86
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$131.81
|
| Rate for Payer: Wellcare Medicare Advantage |
$170.66
|
|
|
NURSING FACILITY CARE INITIA(T
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
510T0062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$1,191.36 |
| Rate for Payer: Aetna Commercial |
$955.57
|
| Rate for Payer: Anthem Medicaid |
$426.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.98
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$1,030.03
|
| Rate for Payer: First Health Commercial |
$1,178.95
|
| Rate for Payer: Humana Commercial |
$1,054.85
|
| Rate for Payer: Humana KY Medicaid |
$426.78
|
| Rate for Payer: Kentucky WC Medicaid |
$431.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,017.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.08
|
| Rate for Payer: Ohio Health Group HMO |
$930.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,079.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.29
|
| Rate for Payer: PHCS Commercial |
$1,191.36
|
| Rate for Payer: United Healthcare All Payer |
$1,092.08
|
|
|
NURSING FACILITY CARE INITIA(T
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 99306
|
| Hospital Charge Code |
510T0062
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$1,191.36 |
| Rate for Payer: Aetna Commercial |
$955.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.98
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$1,030.03
|
| Rate for Payer: First Health Commercial |
$1,178.95
|
| Rate for Payer: Humana Commercial |
$1,054.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,017.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.08
|
| Rate for Payer: Ohio Health Group HMO |
$930.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,079.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.29
|
| Rate for Payer: PHCS Commercial |
$1,191.36
|
| Rate for Payer: United Healthcare All Payer |
$1,092.08
|
|
|
NURSING FACILITY CARE SUBSQN(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
510P0064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$95.50 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Ambetter Exchange |
$69.48
|
| Rate for Payer: Anthem Medicaid |
$42.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.38
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Healthspan PPO |
$71.00
|
| Rate for Payer: Humana Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Molina Healthcare Passport |
$42.19
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.32
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: United Healthcare Non-Options |
$65.77
|
| Rate for Payer: United Healthcare Options |
$53.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.48
|
|
|
NURSING FACILITY CARE SUBSQN(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99310
|
| Hospital Charge Code |
510P0066
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$187.39 |
| Rate for Payer: Aetna Commercial |
$187.39
|
| Rate for Payer: Ambetter Exchange |
$144.11
|
| Rate for Payer: Anthem Medicaid |
$74.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.93
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.89
|
| Rate for Payer: Healthspan PPO |
$139.30
|
| Rate for Payer: Humana Medicaid |
$74.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.98
|
| Rate for Payer: Molina Healthcare Passport |
$74.49
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.34
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.11
|
|
|
NURSING FACILITY CARE SUBSQN(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
510P0063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$62.61 |
| Rate for Payer: Aetna Commercial |
$62.61
|
| Rate for Payer: Ambetter Exchange |
$37.24
|
| Rate for Payer: Anthem Medicaid |
$34.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.69
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Healthspan PPO |
$46.54
|
| Rate for Payer: Humana Medicaid |
$34.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.11
|
| Rate for Payer: Molina Healthcare Passport |
$34.42
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$26.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.24
|
|
|
NURSING FACILITY CARE SUBSQN(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
510P0065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$131.21 |
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Ambetter Exchange |
$100.93
|
| Rate for Payer: Anthem Medicaid |
$59.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.12
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$112.61
|
| Rate for Payer: Healthspan PPO |
$94.37
|
| Rate for Payer: Humana Medicaid |
$59.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.70
|
| Rate for Payer: Molina Healthcare Passport |
$59.51
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.21
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: United Healthcare Non-Options |
$87.43
|
| Rate for Payer: United Healthcare Options |
$71.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.93
|
|
|
NURSING FACILITY CARE SUBSQN(T
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
510T0063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$68.16 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.38
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$58.93
|
| Rate for Payer: First Health Commercial |
$67.45
|
| Rate for Payer: Humana Commercial |
$60.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.48
|
| Rate for Payer: Ohio Health Group HMO |
$53.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.99
|
| Rate for Payer: PHCS Commercial |
$68.16
|
| Rate for Payer: United Healthcare All Payer |
$62.48
|
|
|
NURSING FACILITY CARE SUBSQN(T
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
510T0063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.30 |
| Max. Negotiated Rate |
$68.16 |
| Rate for Payer: Aetna Commercial |
$54.67
|
| Rate for Payer: Anthem Medicaid |
$24.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.38
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cigna Commercial |
$58.93
|
| Rate for Payer: First Health Commercial |
$67.45
|
| Rate for Payer: Humana Commercial |
$60.35
|
| Rate for Payer: Humana KY Medicaid |
$24.42
|
| Rate for Payer: Kentucky WC Medicaid |
$24.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$58.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$52.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$62.48
|
| Rate for Payer: Ohio Health Group HMO |
$53.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$61.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.99
|
| Rate for Payer: PHCS Commercial |
$68.16
|
| Rate for Payer: United Healthcare All Payer |
$62.48
|
|
|
NURSING FACILITY CARE SUBSQN(T
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
510T0064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem Medicaid |
$36.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Humana KY Medicaid |
$36.80
|
| Rate for Payer: Kentucky WC Medicaid |
$37.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$37.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
NURSING FACILITY CARE SUBSQN(T
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
510T0065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.96
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
NURSING FACILITY CARE SUBSQN(T
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
510T0065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$174.72 |
| Rate for Payer: Aetna Commercial |
$140.14
|
| Rate for Payer: Anthem Medicaid |
$62.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.96
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cigna Commercial |
$151.06
|
| Rate for Payer: First Health Commercial |
$172.90
|
| Rate for Payer: Humana Commercial |
$154.70
|
| Rate for Payer: Humana KY Medicaid |
$62.59
|
| Rate for Payer: Kentucky WC Medicaid |
$63.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$149.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$134.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$63.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$160.16
|
| Rate for Payer: Ohio Health Group HMO |
$136.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$158.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.58
|
| Rate for Payer: PHCS Commercial |
$174.72
|
| Rate for Payer: United Healthcare All Payer |
$160.16
|
|
|
NURSING FACILITY CARE SUBSQN(T
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
510T0064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$102.72 |
| Rate for Payer: Aetna Commercial |
$82.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83.46
|
| Rate for Payer: Cash Price |
$53.50
|
| Rate for Payer: Cigna Commercial |
$88.81
|
| Rate for Payer: First Health Commercial |
$101.65
|
| Rate for Payer: Humana Commercial |
$90.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$94.16
|
| Rate for Payer: Ohio Health Group HMO |
$80.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$85.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$93.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.83
|
| Rate for Payer: PHCS Commercial |
$102.72
|
| Rate for Payer: United Healthcare All Payer |
$94.16
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
51000063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
51000065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem Medicaid |
$103.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.56
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Humana KY Medicaid |
$103.86
|
| Rate for Payer: Kentucky WC Medicaid |
$104.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.38
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Ambetter Exchange |
$69.48
|
| Rate for Payer: Anthem Medicaid |
$42.19
|
| Rate for Payer: Buckeye Individual/Medicaid |
$69.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$83.38
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Healthspan PPO |
$71.00
|
| Rate for Payer: Humana Medicaid |
$42.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$88.40
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$69.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$69.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.03
|
| Rate for Payer: Molina Healthcare Passport |
$42.19
|
| Rate for Payer: Multiplan PHCS |
$124.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$90.32
|
| Rate for Payer: UHCCP Medicaid |
$72.45
|
| Rate for Payer: United Healthcare Non-Options |
$65.77
|
| Rate for Payer: United Healthcare Options |
$53.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$42.61
|
| Rate for Payer: Wellcare Medicare Advantage |
$69.48
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem Medicaid |
$71.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Humana KY Medicaid |
$71.19
|
| Rate for Payer: Kentucky WC Medicaid |
$71.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
51000065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.51 |
| Max. Negotiated Rate |
$181.20 |
| Rate for Payer: Aetna Commercial |
$126.94
|
| Rate for Payer: Ambetter Exchange |
$100.93
|
| Rate for Payer: Anthem Medicaid |
$59.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$100.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.12
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$112.61
|
| Rate for Payer: Healthspan PPO |
$94.37
|
| Rate for Payer: Humana Medicaid |
$59.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.08
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$60.70
|
| Rate for Payer: Molina Healthcare Passport |
$59.51
|
| Rate for Payer: Multiplan PHCS |
$181.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.21
|
| Rate for Payer: UHCCP Medicaid |
$105.70
|
| Rate for Payer: United Healthcare Non-Options |
$87.43
|
| Rate for Payer: United Healthcare Options |
$71.57
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$60.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.93
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
51000063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$140.16 |
| Rate for Payer: Aetna Commercial |
$112.42
|
| Rate for Payer: Anthem Medicaid |
$50.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$113.88
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$121.18
|
| Rate for Payer: First Health Commercial |
$138.70
|
| Rate for Payer: Humana Commercial |
$124.10
|
| Rate for Payer: Humana KY Medicaid |
$50.21
|
| Rate for Payer: Kentucky WC Medicaid |
$50.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$119.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$107.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$43.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$51.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$128.48
|
| Rate for Payer: Ohio Health Group HMO |
$109.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$127.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.74
|
| Rate for Payer: PHCS Commercial |
$140.16
|
| Rate for Payer: United Healthcare All Payer |
$128.48
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS 99308
|
| Hospital Charge Code |
51000064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$159.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$161.46
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$171.81
|
| Rate for Payer: First Health Commercial |
$196.65
|
| Rate for Payer: Humana Commercial |
$175.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$169.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$62.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$182.16
|
| Rate for Payer: Ohio Health Group HMO |
$155.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$165.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$180.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$142.83
|
| Rate for Payer: PHCS Commercial |
$198.72
|
| Rate for Payer: United Healthcare All Payer |
$182.16
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 99307
|
| Hospital Charge Code |
51000063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.42 |
| Max. Negotiated Rate |
$87.60 |
| Rate for Payer: Aetna Commercial |
$62.61
|
| Rate for Payer: Ambetter Exchange |
$37.24
|
| Rate for Payer: Anthem Medicaid |
$34.42
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.69
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cash Price |
$73.00
|
| Rate for Payer: Cigna Commercial |
$53.50
|
| Rate for Payer: Healthspan PPO |
$46.54
|
| Rate for Payer: Humana Medicaid |
$34.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$57.34
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$35.11
|
| Rate for Payer: Molina Healthcare Passport |
$34.42
|
| Rate for Payer: Multiplan PHCS |
$87.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.41
|
| Rate for Payer: UHCCP Medicaid |
$51.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$34.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.24
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 99309
|
| Hospital Charge Code |
51000065
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$289.92 |
| Rate for Payer: Aetna Commercial |
$232.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$235.56
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna Commercial |
$250.66
|
| Rate for Payer: First Health Commercial |
$286.90
|
| Rate for Payer: Humana Commercial |
$256.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$247.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$222.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$265.76
|
| Rate for Payer: Ohio Health Group HMO |
$226.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$208.38
|
| Rate for Payer: PHCS Commercial |
$289.92
|
| Rate for Payer: United Healthcare All Payer |
$265.76
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 99310
|
| Hospital Charge Code |
51000066
|
|
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
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99310
|
| Hospital Charge Code |
51000066
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$187.39 |
| Rate for Payer: Aetna Commercial |
$187.39
|
| Rate for Payer: Ambetter Exchange |
$144.11
|
| Rate for Payer: Anthem Medicaid |
$74.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.93
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.89
|
| Rate for Payer: Healthspan PPO |
$139.30
|
| Rate for Payer: Humana Medicaid |
$74.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.98
|
| Rate for Payer: Molina Healthcare Passport |
$74.49
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.34
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.11
|
|
|
NURSING FACILITY CARE SUBSQNT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 99310
|
| Hospital Charge Code |
51000066
|
|
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
|
|
