|
PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
51000344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
51000344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$24.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$24.07
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$24.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.70
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
PT-FOCUSED HLTH RISK ASSMT (P
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
510P0344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$6.23
|
| Rate for Payer: Humana Medicaid |
$3.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.45
|
| Rate for Payer: Molina Healthcare Passport |
$3.38
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
|
|
PT-FOCUSED HLTH RISK ASSMT (T
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
510T0344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.40
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
PT-FOCUSED HLTH RISK ASSMT (T
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
510T0344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$24.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$34.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.49
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$33.20
|
| Rate for Payer: First Health Commercial |
$38.00
|
| Rate for Payer: Humana Commercial |
$34.00
|
| Rate for Payer: Humana KY Medicaid |
$13.76
|
| Rate for Payer: Humana Medicare Advantage |
$24.81
|
| Rate for Payer: Kentucky WC Medicaid |
$13.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$32.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$29.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$35.20
|
| Rate for Payer: Ohio Health Group HMO |
$30.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12.40
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
PT HYBRID GLEN POST-REGENEREX
|
Facility
|
OP
|
$3,715.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.02 |
| Max. Negotiated Rate |
$3,566.88 |
| Rate for Payer: Aetna Commercial |
$2,860.94
|
| Rate for Payer: Anthem Medicaid |
$1,277.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,898.09
|
| Rate for Payer: Cash Price |
$1,857.75
|
| Rate for Payer: Cigna Commercial |
$3,083.86
|
| Rate for Payer: First Health Commercial |
$3,529.72
|
| Rate for Payer: Humana Commercial |
$3,158.18
|
| Rate for Payer: Humana KY Medicaid |
$1,277.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,290.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,046.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,742.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,303.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,269.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,786.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,151.80
|
| Rate for Payer: PHCS Commercial |
$3,566.88
|
| Rate for Payer: United Healthcare All Payer |
$3,269.64
|
|
|
PT HYBRID GLEN POST-REGENEREX
|
Facility
|
IP
|
$3,715.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.02 |
| Max. Negotiated Rate |
$3,566.88 |
| Rate for Payer: Aetna Commercial |
$2,860.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,898.09
|
| Rate for Payer: Cash Price |
$1,857.75
|
| Rate for Payer: Cigna Commercial |
$3,083.86
|
| Rate for Payer: First Health Commercial |
$3,529.72
|
| Rate for Payer: Humana Commercial |
$3,158.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,046.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,742.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,269.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,786.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,151.80
|
| Rate for Payer: PHCS Commercial |
$3,566.88
|
| Rate for Payer: United Healthcare All Payer |
$3,269.64
|
|
|
PT RE EVAL CARE PLAN
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
HCPCS 97164
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem Medicaid |
$40.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Humana KY Medicaid |
$40.92
|
| Rate for Payer: Kentucky WC Medicaid |
$41.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$41.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
PT RE EVAL CARE PLAN
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
HCPCS 97164
|
| Hospital Charge Code |
42000028
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$114.24 |
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$92.82
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cigna Commercial |
$98.77
|
| Rate for Payer: First Health Commercial |
$113.05
|
| Rate for Payer: Humana Commercial |
$101.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$97.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$87.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$104.72
|
| Rate for Payer: Ohio Health Group HMO |
$89.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$36.89
|
| Rate for Payer: PHCS Commercial |
$114.24
|
| Rate for Payer: United Healthcare All Payer |
$104.72
|
|
|
PT SELF CARE
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$35.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Humana KY Medicaid |
$35.08
|
| Rate for Payer: Kentucky WC Medicaid |
$35.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
PT SELF CARE
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 97535
|
| Hospital Charge Code |
42000030
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$13.26 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$84.66
|
| Rate for Payer: First Health Commercial |
$96.90
|
| Rate for Payer: Humana Commercial |
$86.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$83.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$75.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$89.76
|
| Rate for Payer: Ohio Health Group HMO |
$76.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$31.62
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
PTT-ACTIVATE PLASMA OR WH BLD
|
Facility
|
IP
|
$108.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
30000630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.04 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
PTT-ACTIVATE PLASMA OR WH BLD
|
Facility
|
OP
|
$108.00
|
|
|
Service Code
|
HCPCS 85730
|
| Hospital Charge Code |
30000630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$103.68 |
| Rate for Payer: Aetna Commercial |
$83.16
|
| Rate for Payer: Anthem Medicaid |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$89.64
|
| Rate for Payer: First Health Commercial |
$102.60
|
| Rate for Payer: Humana Commercial |
$91.80
|
| Rate for Payer: Humana KY Medicaid |
$6.01
|
| Rate for Payer: Humana Medicare Advantage |
$6.01
|
| Rate for Payer: Kentucky WC Medicaid |
$6.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$88.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$79.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$95.04
|
| Rate for Payer: Ohio Health Group HMO |
$81.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33.48
|
| Rate for Payer: PHCS Commercial |
$103.68
|
| Rate for Payer: United Healthcare All Payer |
$95.04
|
|
|
PTT SUBS PLASMA FRACTIONS EA
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem Medicaid |
$6.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.06
|
| Rate for Payer: CareSource Just4Me Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Humana KY Medicaid |
$6.47
|
| Rate for Payer: Humana Medicare Advantage |
$6.47
|
| Rate for Payer: Kentucky WC Medicaid |
$6.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$6.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
PTT SUBS PLASMA FRACTIONS EA
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 85732
|
| Hospital Charge Code |
30000632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$238.08 |
| Rate for Payer: Aetna Commercial |
$190.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$199.14
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cigna Commercial |
$205.84
|
| Rate for Payer: First Health Commercial |
$235.60
|
| Rate for Payer: Humana Commercial |
$210.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$203.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$183.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$74.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$218.24
|
| Rate for Payer: Ohio Health Group HMO |
$186.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$49.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$32.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76.88
|
| Rate for Payer: PHCS Commercial |
$238.08
|
| Rate for Payer: United Healthcare All Payer |
$218.24
|
|
|
PT WHEELCHAIR TRAINING 15 MIN
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
42000032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem Medicaid |
$22.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.92
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Humana KY Medicaid |
$22.01
|
| Rate for Payer: Kentucky WC Medicaid |
$22.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
PT WHEELCHAIR TRAINING 15 MIN
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS 97542
|
| Hospital Charge Code |
42000032
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$61.44 |
| Rate for Payer: Aetna Commercial |
$49.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49.92
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cigna Commercial |
$53.12
|
| Rate for Payer: First Health Commercial |
$60.80
|
| Rate for Payer: Humana Commercial |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$56.32
|
| Rate for Payer: Ohio Health Group HMO |
$48.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19.84
|
| Rate for Payer: PHCS Commercial |
$61.44
|
| Rate for Payer: United Healthcare All Payer |
$56.32
|
|
|
PULM FUNCTION DISABILITY
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem Medicaid |
$70.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Humana KY Medicaid |
$70.84
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$71.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$72.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
PULM FUNCTION DISABILITY
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
HCPCS 94060
|
| Hospital Charge Code |
46000025
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$197.76 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$160.68
|
| Rate for Payer: Cash Price |
$103.00
|
| Rate for Payer: Cigna Commercial |
$170.98
|
| Rate for Payer: First Health Commercial |
$195.70
|
| Rate for Payer: Humana Commercial |
$175.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$168.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$152.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$181.28
|
| Rate for Payer: Ohio Health Group HMO |
$154.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$63.86
|
| Rate for Payer: PHCS Commercial |
$197.76
|
| Rate for Payer: United Healthcare All Payer |
$181.28
|
|
|
PULM FUNCTION DISABILITY 2
|
Facility
|
IP
|
$199.00
|
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
469
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.69
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
PULM FUNCTION DISABILITY 2
|
Facility
|
OP
|
$199.00
|
|
| Hospital Charge Code |
46000026
|
|
Hospital Revenue Code
|
469
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$191.04 |
| Rate for Payer: Aetna Commercial |
$153.23
|
| Rate for Payer: Anthem Medicaid |
$68.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$155.22
|
| Rate for Payer: Cash Price |
$99.50
|
| Rate for Payer: Cigna Commercial |
$165.17
|
| Rate for Payer: First Health Commercial |
$189.05
|
| Rate for Payer: Humana Commercial |
$169.15
|
| Rate for Payer: Humana KY Medicaid |
$68.44
|
| Rate for Payer: Kentucky WC Medicaid |
$69.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$163.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$146.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$59.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$69.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$175.12
|
| Rate for Payer: Ohio Health Group HMO |
$149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$39.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$61.69
|
| Rate for Payer: PHCS Commercial |
$191.04
|
| Rate for Payer: United Healthcare All Payer |
$175.12
|
|
|
PULM FUNCT TEST OSCILLOMETR(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
460P0014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$69.47 |
| Rate for Payer: Anthem Medicaid |
$30.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$69.47
|
| Rate for Payer: Healthspan PPO |
$35.92
|
| Rate for Payer: Humana Medicaid |
$30.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.27
|
| Rate for Payer: Molina Healthcare Passport |
$30.66
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.97
|
|
|
PULM FUNCT TEST OSCILLOMETR(T
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
460T0014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem Medicaid |
$137.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$135.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$189.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$182.36
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Humana KY Medicaid |
$137.90
|
| Rate for Payer: Humana Medicare Advantage |
$135.08
|
| Rate for Payer: Kentucky WC Medicaid |
$139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.31
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
PULM FUNCT TEST OSCILLOMETR(T
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
460T0014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$124.31
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
PULM FUNCT TEST OSCILLOMETRY
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 94728
|
| Hospital Charge Code |
46000014
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$451.00 |
| Rate for Payer: Anthem Medicaid |
$30.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$451.00
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cigna Commercial |
$69.47
|
| Rate for Payer: Healthspan PPO |
$35.92
|
| Rate for Payer: Humana Medicaid |
$30.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.27
|
| Rate for Payer: Molina Healthcare Passport |
$30.66
|
| Rate for Payer: Multiplan PHCS |
$270.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$315.70
|
| Rate for Payer: UHCCP Medicaid |
$157.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$30.97
|
|
