|
PTA VENOUS(T
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37249
|
| Hospital Charge Code |
761T1571
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,787.10 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
OP
|
$13,240.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
76101570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,553.24 |
| Max. Negotiated Rate |
$12,710.40 |
| Rate for Payer: Aetna Commercial |
$10,194.80
|
| Rate for Payer: Anthem Medicaid |
$4,553.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,327.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cigna Commercial |
$10,989.20
|
| Rate for Payer: First Health Commercial |
$12,578.00
|
| Rate for Payer: Humana Commercial |
$11,254.00
|
| Rate for Payer: Humana KY Medicaid |
$4,553.24
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,599.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,856.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,771.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,644.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,651.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,518.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,135.60
|
| Rate for Payer: PHCS Commercial |
$12,710.40
|
| Rate for Payer: United Healthcare All Payer |
$11,651.20
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,048.61 |
| Max. Negotiated Rate |
$7,375.33 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem Medicaid |
$2,048.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Humana KY Medicaid |
$2,048.61
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,069.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,089.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Professional
|
Both
|
$13,240.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
76101570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Ambetter Exchange |
$276.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.78
|
| Rate for Payer: Anthem Medicaid |
$1,111.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.92
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cigna Commercial |
$561.10
|
| Rate for Payer: Humana Medicaid |
$1,111.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,133.28
|
| Rate for Payer: Molina Healthcare Passport |
$1,111.06
|
| Rate for Payer: Multiplan PHCS |
$7,944.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.58
|
| Rate for Payer: UHCCP Medicaid |
$262.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,122.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.60
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
48100038
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,787.10 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$4,586.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,646.46
|
| Rate for Payer: Cash Price |
$2,978.50
|
| Rate for Payer: Cigna Commercial |
$4,944.31
|
| Rate for Payer: First Health Commercial |
$5,659.15
|
| Rate for Payer: Humana Commercial |
$5,063.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,884.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,396.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,787.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,242.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,467.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,182.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,110.33
|
| Rate for Payer: PHCS Commercial |
$5,718.72
|
| Rate for Payer: United Healthcare All Payer |
$5,242.16
|
|
|
PTCA ARTERIAL PERIPHERAL
|
Facility
|
IP
|
$13,240.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
76101570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,972.00 |
| Max. Negotiated Rate |
$12,710.40 |
| Rate for Payer: Aetna Commercial |
$10,194.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,327.20
|
| Rate for Payer: Cash Price |
$6,620.00
|
| Rate for Payer: Cigna Commercial |
$10,989.20
|
| Rate for Payer: First Health Commercial |
$12,578.00
|
| Rate for Payer: Humana Commercial |
$11,254.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,856.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,771.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,972.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,651.20
|
| Rate for Payer: Ohio Health Group HMO |
$9,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,518.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,135.60
|
| Rate for Payer: PHCS Commercial |
$12,710.40
|
| Rate for Payer: United Healthcare All Payer |
$11,651.20
|
|
|
PTCA ARTERIAL PERIPHERAL(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
761P1570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.78 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Ambetter Exchange |
$276.60
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$249.78
|
| Rate for Payer: Anthem Medicaid |
$1,111.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$276.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$276.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$331.92
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$561.10
|
| Rate for Payer: Humana Medicaid |
$1,111.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$397.02
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$276.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$276.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,133.28
|
| Rate for Payer: Molina Healthcare Passport |
$1,111.06
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$359.58
|
| Rate for Payer: UHCCP Medicaid |
$262.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,122.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$276.60
|
|
|
PTCA ARTERIAL PERIPHERAL(T
|
Facility
|
OP
|
$10,740.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
761T1570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,693.49 |
| Max. Negotiated Rate |
$10,310.40 |
| Rate for Payer: Aetna Commercial |
$8,269.80
|
| Rate for Payer: Anthem Medicaid |
$3,693.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,268.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,377.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$7,375.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,111.92
|
| Rate for Payer: Cash Price |
$5,370.00
|
| Rate for Payer: Cash Price |
$5,370.00
|
| Rate for Payer: Cigna Commercial |
$8,914.20
|
| Rate for Payer: First Health Commercial |
$10,203.00
|
| Rate for Payer: Humana Commercial |
$9,129.00
|
| Rate for Payer: Humana KY Medicaid |
$3,693.49
|
| Rate for Payer: Humana Medicare Advantage |
$5,268.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,731.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,926.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,321.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,767.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,451.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,343.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,410.60
|
| Rate for Payer: PHCS Commercial |
$10,310.40
|
| Rate for Payer: United Healthcare All Payer |
$9,451.20
|
|
|
PTCA ARTERIAL PERIPHERAL(T
|
Facility
|
IP
|
$10,740.00
|
|
|
Service Code
|
HCPCS 37248
|
| Hospital Charge Code |
761T1570
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,222.00 |
| Max. Negotiated Rate |
$10,310.40 |
| Rate for Payer: Aetna Commercial |
$8,269.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,377.20
|
| Rate for Payer: Cash Price |
$5,370.00
|
| Rate for Payer: Cigna Commercial |
$8,914.20
|
| Rate for Payer: First Health Commercial |
$10,203.00
|
| Rate for Payer: Humana Commercial |
$9,129.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,926.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,222.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,451.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,055.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,343.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,410.60
|
| Rate for Payer: PHCS Commercial |
$10,310.40
|
| Rate for Payer: United Healthcare All Payer |
$9,451.20
|
|
|
PT/CAREGIVER TRAING HOME INR
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93792
|
| Hospital Charge Code |
51000180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$79.07 |
| Rate for Payer: Ambetter Exchange |
$60.82
|
| Rate for Payer: Anthem Medicaid |
$39.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$60.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$60.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$72.98
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$73.31
|
| Rate for Payer: Humana Medicaid |
$39.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$60.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$40.71
|
| Rate for Payer: Molina Healthcare Passport |
$39.91
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.07
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.31
|
| Rate for Payer: Wellcare Medicare Advantage |
$60.82
|
|
|
PT COMM/WORK REINTEGRATION
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
PT COMM/WORK REINTEGRATION
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 97537
|
| Hospital Charge Code |
42000031
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
PT EVAL HIGH
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
HCPCS 97163
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
PT EVAL HIGH
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
HCPCS 97163
|
| Hospital Charge Code |
42000027
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: Aetna Commercial |
$257.95
|
| Rate for Payer: Anthem Medicaid |
$115.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$261.30
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$278.05
|
| Rate for Payer: First Health Commercial |
$318.25
|
| Rate for Payer: Humana Commercial |
$284.75
|
| Rate for Payer: Humana KY Medicaid |
$115.21
|
| Rate for Payer: Kentucky WC Medicaid |
$116.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$274.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$247.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$117.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$294.80
|
| Rate for Payer: Ohio Health Group HMO |
$251.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$268.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$291.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.15
|
| Rate for Payer: PHCS Commercial |
$321.60
|
| Rate for Payer: United Healthcare All Payer |
$294.80
|
|
|
PT EVAL LOW
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS 97161
|
| Hospital Charge Code |
42000025
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$254.87
|
| Rate for Payer: Anthem Medicaid |
$113.83
|
| 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: Humana KY Medicaid |
$113.83
|
| 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 |
$99.30
|
| 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
|
|
|
PT EVAL LOW
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS 97161
|
| Hospital Charge Code |
42000025
|
|
Hospital Revenue Code
|
424
|
| 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
|
|
|
PT EVAL MOD
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
HCPCS 97162
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem Medicaid |
$116.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Humana KY Medicaid |
$116.93
|
| Rate for Payer: Kentucky WC Medicaid |
$118.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$119.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
PT EVAL MOD
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
HCPCS 97162
|
| Hospital Charge Code |
42000026
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$326.40 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$265.20
|
| Rate for Payer: Cash Price |
$170.00
|
| Rate for Payer: Cigna Commercial |
$282.20
|
| Rate for Payer: First Health Commercial |
$323.00
|
| Rate for Payer: Humana Commercial |
$289.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$278.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$250.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$299.20
|
| Rate for Payer: Ohio Health Group HMO |
$255.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$272.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$295.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.60
|
| Rate for Payer: PHCS Commercial |
$326.40
|
| Rate for Payer: United Healthcare All Payer |
$299.20
|
|
|
PT-FOCUSED HLTH RISK ASSMT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
51000344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$42.00 |
| Rate for Payer: Ambetter Exchange |
$2.65
|
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.18
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.45
|
| Rate for Payer: Molina Healthcare Passport |
$3.38
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.44
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.65
|
|
|
PT-FOCUSED HLTH RISK ASSMT
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 96160
|
| Hospital Charge Code |
51000344
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.00 |
| 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 |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| 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 |
$24.07 |
| 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 |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| 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 |
$27.53
|
| 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 |
$33.04
|
| 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 |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| 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 |
$2.65 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Ambetter Exchange |
$2.65
|
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.65
|
| 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 |
$3.44
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.65
|
|
|
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 |
$12.00 |
| 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 |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.60
|
| 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 |
$13.76 |
| Max. Negotiated Rate |
$38.54 |
| Rate for Payer: Aetna Commercial |
$30.80
|
| Rate for Payer: Anthem Medicaid |
$13.76
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| 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 |
$27.53
|
| 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 |
$33.04
|
| 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 |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$27.60
|
| Rate for Payer: PHCS Commercial |
$38.40
|
| Rate for Payer: United Healthcare All Payer |
$35.20
|
|
|
PT HYBRID GLEN POST-REGENEREX
|
Facility
|
OP
|
$3,623.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.12 |
| Max. Negotiated Rate |
$3,478.80 |
| Rate for Payer: Aetna Commercial |
$2,790.29
|
| Rate for Payer: Anthem Medicaid |
$1,246.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,826.53
|
| Rate for Payer: Cash Price |
$1,811.88
|
| Rate for Payer: Cigna Commercial |
$3,007.71
|
| Rate for Payer: First Health Commercial |
$3,442.56
|
| Rate for Payer: Humana Commercial |
$3,080.19
|
| Rate for Payer: Humana KY Medicaid |
$1,246.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,258.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,971.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,271.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,188.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,717.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,899.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,152.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,500.39
|
| Rate for Payer: PHCS Commercial |
$3,478.80
|
| Rate for Payer: United Healthcare All Payer |
$3,188.90
|
|
