|
PSYCHOTHERAPY 45 MIN W/PT EV
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
90000018
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$345.17 |
| Rate for Payer: Aetna Commercial |
$276.85
|
| Rate for Payer: Anthem Medicaid |
$123.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$280.45
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cigna Commercial |
$298.43
|
| Rate for Payer: First Health Commercial |
$341.57
|
| Rate for Payer: Humana Commercial |
$305.62
|
| Rate for Payer: Humana KY Medicaid |
$123.65
|
| Rate for Payer: Kentucky WC Medicaid |
$124.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$294.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$265.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$107.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$126.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$316.40
|
| Rate for Payer: Ohio Health Group HMO |
$269.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$312.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.09
|
| Rate for Payer: PHCS Commercial |
$345.17
|
| Rate for Payer: United Healthcare All Payer |
$316.40
|
|
|
PSYCHOTHERAPY 45 MIN W/PT EV(P
|
Professional
|
Both
|
$359.55
|
|
|
Service Code
|
HCPCS 90836
|
| Hospital Charge Code |
900P0018
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$47.45 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna Commercial |
$150.39
|
| Rate for Payer: Ambetter Exchange |
$80.86
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$47.45
|
| Rate for Payer: Anthem Medicaid |
$61.17
|
| Rate for Payer: Buckeye Individual/Medicaid |
$80.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.86
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.03
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cash Price |
$179.78
|
| Rate for Payer: Cigna Commercial |
$100.33
|
| Rate for Payer: Healthspan PPO |
$60.02
|
| Rate for Payer: Humana Medicaid |
$61.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$80.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.86
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$62.39
|
| Rate for Payer: Molina Healthcare Passport |
$61.17
|
| Rate for Payer: Multiplan PHCS |
$215.73
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.12
|
| Rate for Payer: UHCCP Medicaid |
$49.82
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$61.78
|
| Rate for Payer: Wellcare Medicare Advantage |
$80.86
|
|
|
PSYCHOTHERAPY, 60 MIN PT/FAM
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
90000008
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$154.50 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$154.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
PSYCHOTHERAPY, 60 MIN PT/FAM
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
90000008
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$207.93
|
| Rate for Payer: Ambetter Exchange |
$133.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.77
|
| Rate for Payer: Anthem Medicaid |
$94.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.02
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$175.91
|
| Rate for Payer: Healthspan PPO |
$165.72
|
| Rate for Payer: Humana Medicaid |
$94.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.01
|
| Rate for Payer: Molina Healthcare Passport |
$94.13
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.35
|
| Rate for Payer: UHCCP Medicaid |
$79.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.35
|
|
|
PSYCHOTHERAPY, 60 MIN PT/FAM
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
90000008
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$494.40 |
| Rate for Payer: Aetna Commercial |
$396.55
|
| Rate for Payer: Anthem Medicaid |
$177.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$148.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$401.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$207.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$200.42
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$427.45
|
| Rate for Payer: First Health Commercial |
$489.25
|
| Rate for Payer: Humana Commercial |
$437.75
|
| Rate for Payer: Humana KY Medicaid |
$177.11
|
| Rate for Payer: Humana Medicare Advantage |
$148.46
|
| Rate for Payer: Kentucky WC Medicaid |
$178.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$422.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$380.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$178.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$453.20
|
| Rate for Payer: Ohio Health Group HMO |
$386.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.35
|
| Rate for Payer: PHCS Commercial |
$494.40
|
| Rate for Payer: United Healthcare All Payer |
$453.20
|
|
|
PSYCHOTHERAPY, 60 MIN PT/FAM(P
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 90837
|
| Hospital Charge Code |
900P0008
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$309.00 |
| Rate for Payer: Aetna Commercial |
$207.93
|
| Rate for Payer: Ambetter Exchange |
$133.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$75.77
|
| Rate for Payer: Anthem Medicaid |
$94.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$133.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$133.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.02
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cash Price |
$257.50
|
| Rate for Payer: Cigna Commercial |
$175.91
|
| Rate for Payer: Healthspan PPO |
$165.72
|
| Rate for Payer: Humana Medicaid |
$94.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$152.33
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$133.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$96.01
|
| Rate for Payer: Molina Healthcare Passport |
$94.13
|
| Rate for Payer: Multiplan PHCS |
$309.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$173.35
|
| Rate for Payer: UHCCP Medicaid |
$79.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$95.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$133.35
|
|
|
PSYCHOTHERAPY W/PT 60 MIN W/EM
|
Facility
|
OP
|
$426.50
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
90000027
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$127.95 |
| Max. Negotiated Rate |
$409.44 |
| Rate for Payer: Aetna Commercial |
$328.40
|
| Rate for Payer: Anthem Medicaid |
$146.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.67
|
| Rate for Payer: Cash Price |
$213.25
|
| Rate for Payer: Cigna Commercial |
$354.00
|
| Rate for Payer: First Health Commercial |
$405.18
|
| Rate for Payer: Humana Commercial |
$362.52
|
| Rate for Payer: Humana KY Medicaid |
$146.67
|
| Rate for Payer: Kentucky WC Medicaid |
$148.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$349.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$314.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$149.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.32
|
| Rate for Payer: Ohio Health Group HMO |
$319.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.29
|
| Rate for Payer: PHCS Commercial |
$409.44
|
| Rate for Payer: United Healthcare All Payer |
$375.32
|
|
|
PSYCHOTHERAPY W/PT 60 MIN W/EM
|
Facility
|
IP
|
$426.50
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
90000027
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$127.95 |
| Max. Negotiated Rate |
$409.44 |
| Rate for Payer: Aetna Commercial |
$328.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$332.67
|
| Rate for Payer: Cash Price |
$213.25
|
| Rate for Payer: Cigna Commercial |
$354.00
|
| Rate for Payer: First Health Commercial |
$405.18
|
| Rate for Payer: Humana Commercial |
$362.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$349.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$314.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$127.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$375.32
|
| Rate for Payer: Ohio Health Group HMO |
$319.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$371.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$294.29
|
| Rate for Payer: PHCS Commercial |
$409.44
|
| Rate for Payer: United Healthcare All Payer |
$375.32
|
|
|
PSYCHOTHERAPY W/PT 60 MIN W/EM
|
Professional
|
Both
|
$426.50
|
|
|
Service Code
|
HCPCS 90838
|
| Hospital Charge Code |
90000027
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$76.91 |
| Max. Negotiated Rate |
$255.90 |
| Rate for Payer: Aetna Commercial |
$220.07
|
| Rate for Payer: Ambetter Exchange |
$108.00
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$76.91
|
| Rate for Payer: Anthem Medicaid |
$80.73
|
| Rate for Payer: Buckeye Individual/Medicaid |
$108.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$108.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$129.60
|
| Rate for Payer: Cash Price |
$213.25
|
| Rate for Payer: Cash Price |
$213.25
|
| Rate for Payer: Cigna Commercial |
$162.06
|
| Rate for Payer: Healthspan PPO |
$96.70
|
| Rate for Payer: Humana Medicaid |
$80.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.77
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$108.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$108.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.34
|
| Rate for Payer: Molina Healthcare Passport |
$80.73
|
| Rate for Payer: Multiplan PHCS |
$255.90
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.40
|
| Rate for Payer: UHCCP Medicaid |
$80.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$81.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$108.00
|
|
|
PSYCL/NRPSYC TST AUTO RESULT
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
51000051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$97.92 |
| Rate for Payer: Aetna Commercial |
$78.54
|
| Rate for Payer: Anthem Medicaid |
$35.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$79.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$51.00
|
| 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: Humana Medicare Advantage |
$22.63
|
| 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 |
$27.16
|
| 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 |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.38
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
PSYCL/NRPSYC TST AUTO RESULT
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
51000051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.60 |
| 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 |
$81.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$88.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$70.38
|
| Rate for Payer: PHCS Commercial |
$97.92
|
| Rate for Payer: United Healthcare All Payer |
$89.76
|
|
|
PSYCL/NRPSYC TST AUTO RESULT
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
51000051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Ambetter Exchange |
$2.10
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.52
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$2.89
|
| Rate for Payer: Humana Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1.58
|
| Rate for Payer: Molina Healthcare Passport |
$1.55
|
| Rate for Payer: Multiplan PHCS |
$61.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$35.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.10
|
|
|
PSYCL/NRPSYC TST AUTO RESULT(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
510P0051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Ambetter Exchange |
$2.10
|
| Rate for Payer: Anthem Medicaid |
$1.55
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.10
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$2.52
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$2.89
|
| Rate for Payer: Humana Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$2.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$2.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1.58
|
| Rate for Payer: Molina Healthcare Passport |
$1.55
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2.73
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.10
|
|
|
PSYCL/NRPSYC TST AUTO RESULT(T
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
510T0051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
PSYCL/NRPSYC TST AUTO RESULT(T
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS 96146
|
| Hospital Charge Code |
510T0051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$49.92 |
| Rate for Payer: Aetna Commercial |
$40.04
|
| Rate for Payer: Anthem Medicaid |
$17.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$40.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cigna Commercial |
$43.16
|
| Rate for Payer: First Health Commercial |
$49.40
|
| Rate for Payer: Humana Commercial |
$44.20
|
| Rate for Payer: Humana KY Medicaid |
$17.88
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$18.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$42.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$38.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$18.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$45.76
|
| Rate for Payer: Ohio Health Group HMO |
$39.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$41.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.88
|
| Rate for Payer: PHCS Commercial |
$49.92
|
| Rate for Payer: United Healthcare All Payer |
$45.76
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
51000049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$615.36 |
| Rate for Payer: Aetna Commercial |
$493.57
|
| Rate for Payer: Anthem Medicaid |
$220.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cigna Commercial |
$532.03
|
| Rate for Payer: First Health Commercial |
$608.95
|
| Rate for Payer: Humana Commercial |
$544.85
|
| Rate for Payer: Humana KY Medicaid |
$220.44
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$222.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$525.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$473.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$224.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$564.08
|
| Rate for Payer: Ohio Health Group HMO |
$480.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$442.29
|
| Rate for Payer: PHCS Commercial |
$615.36
|
| Rate for Payer: United Healthcare All Payer |
$564.08
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
51000049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$192.30 |
| Max. Negotiated Rate |
$615.36 |
| Rate for Payer: Aetna Commercial |
$493.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$499.98
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cigna Commercial |
$532.03
|
| Rate for Payer: First Health Commercial |
$608.95
|
| Rate for Payer: Humana Commercial |
$544.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$525.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$473.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$192.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$564.08
|
| Rate for Payer: Ohio Health Group HMO |
$480.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$442.29
|
| Rate for Payer: PHCS Commercial |
$615.36
|
| Rate for Payer: United Healthcare All Payer |
$564.08
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
51000049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$384.60 |
| Rate for Payer: Ambetter Exchange |
$104.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.77
|
| Rate for Payer: Anthem Medicaid |
$95.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.45
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cash Price |
$320.50
|
| Rate for Payer: Cigna Commercial |
$166.85
|
| Rate for Payer: Humana Medicaid |
$95.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.00
|
| Rate for Payer: Molina Healthcare Passport |
$95.10
|
| Rate for Payer: Multiplan PHCS |
$384.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.90
|
| Rate for Payer: UHCCP Medicaid |
$53.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.54
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST(P
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
510P0049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Ambetter Exchange |
$104.54
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.77
|
| Rate for Payer: Anthem Medicaid |
$95.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$104.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$104.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$125.45
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cash Price |
$155.00
|
| Rate for Payer: Cigna Commercial |
$166.85
|
| Rate for Payer: Humana Medicaid |
$95.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$140.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$104.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$97.00
|
| Rate for Payer: Molina Healthcare Passport |
$95.10
|
| Rate for Payer: Multiplan PHCS |
$186.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$135.90
|
| Rate for Payer: UHCCP Medicaid |
$53.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$96.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$104.54
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST(T
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
510T0049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.18
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$99.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
PSYCL TST EVAL PHYS/QHP 1ST(T
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 96130
|
| Hospital Charge Code |
510T0049
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem Medicaid |
$113.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$258.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cash Price |
$165.50
|
| Rate for Payer: Cigna Commercial |
$274.73
|
| Rate for Payer: First Health Commercial |
$314.45
|
| Rate for Payer: Humana Commercial |
$281.35
|
| Rate for Payer: Humana KY Medicaid |
$113.83
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$114.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$271.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$244.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$116.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$291.28
|
| Rate for Payer: Ohio Health Group HMO |
$248.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$264.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$228.39
|
| Rate for Payer: PHCS Commercial |
$317.76
|
| Rate for Payer: United Healthcare All Payer |
$291.28
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
OP
|
$340.71
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
51000158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.21 |
| Max. Negotiated Rate |
$327.08 |
| Rate for Payer: Aetna Commercial |
$262.35
|
| Rate for Payer: Anthem Medicaid |
$117.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.75
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cigna Commercial |
$282.79
|
| Rate for Payer: First Health Commercial |
$323.67
|
| Rate for Payer: Humana Commercial |
$289.60
|
| Rate for Payer: Humana KY Medicaid |
$117.17
|
| Rate for Payer: Kentucky WC Medicaid |
$118.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.82
|
| Rate for Payer: Ohio Health Group HMO |
$255.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.09
|
| Rate for Payer: PHCS Commercial |
$327.08
|
| Rate for Payer: United Healthcare All Payer |
$299.82
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Professional
|
Both
|
$340.71
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
51000158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$204.43 |
| Rate for Payer: Ambetter Exchange |
$71.81
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$50.77
|
| Rate for Payer: Anthem Medicaid |
$72.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$71.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$71.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$86.17
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cigna Commercial |
$126.94
|
| Rate for Payer: Humana Medicaid |
$72.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$107.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$71.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$73.84
|
| Rate for Payer: Molina Healthcare Passport |
$72.39
|
| Rate for Payer: Multiplan PHCS |
$204.43
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$93.35
|
| Rate for Payer: UHCCP Medicaid |
$53.31
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$73.11
|
| Rate for Payer: Wellcare Medicare Advantage |
$71.81
|
|
|
PSYCL TST EVAL PHYS/QHP EA
|
Facility
|
IP
|
$340.71
|
|
|
Service Code
|
HCPCS 96131
|
| Hospital Charge Code |
51000158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.21 |
| Max. Negotiated Rate |
$327.08 |
| Rate for Payer: Aetna Commercial |
$262.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.75
|
| Rate for Payer: Cash Price |
$170.35
|
| Rate for Payer: Cigna Commercial |
$282.79
|
| Rate for Payer: First Health Commercial |
$323.67
|
| Rate for Payer: Humana Commercial |
$289.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$279.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$251.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.82
|
| Rate for Payer: Ohio Health Group HMO |
$255.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$296.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$235.09
|
| Rate for Payer: PHCS Commercial |
$327.08
|
| Rate for Payer: United Healthcare All Payer |
$299.82
|
|
|
PSYCL TST EVAL PHYS/QHP EA(P
|
Professional
|
Both
|
$84.71
|
|
| Hospital Charge Code |
510P0158
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.65 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Multiplan PHCS |
$50.83
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$59.30
|
| Rate for Payer: UHCCP Medicaid |
$29.65
|
|
