|
TELEPH E&M BY PHY/QHP 5-10 MIN
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 99441
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$24.80
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
TELEPH E&M BY PHY/QHP 5-10 MIN
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 99441
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.00
|
| Rate for Payer: Anthem Medicaid |
$40.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$19.08
|
| Rate for Payer: Healthspan PPO |
$16.56
|
| Rate for Payer: Humana Medicaid |
$40.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.17
|
| Rate for Payer: Molina Healthcare Passport |
$40.36
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$18.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.76
|
|
|
TELEPH E&M BY PHYS 11-20 MIN
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99442
|
| Hospital Charge Code |
51000162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$39.40
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.57
|
| Rate for Payer: Anthem Medicaid |
$61.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.00
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$34.83
|
| Rate for Payer: Healthspan PPO |
$30.48
|
| Rate for Payer: Humana Medicaid |
$61.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.38
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.22
|
| Rate for Payer: Molina Healthcare Passport |
$61.98
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$35.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.60
|
|
|
TELEPH E&M BY PHYS 11-20 MIN
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
51000162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
TELEPH E&M BY PHYS 11-20 MIN
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
51000162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$35.65
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
TELEPH E&M BY PHYS 21-30 MIN
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99443
|
| Hospital Charge Code |
51000163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.70 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$58.81
|
| Rate for Payer: Anthem Medicaid |
$87.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$51.70
|
| Rate for Payer: Humana Medicaid |
$87.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$52.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Molina Healthcare Passport |
$87.17
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.04
|
|
|
TELEPH E&M BY PHYS 21-30 MIN
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
51000163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Humana KY Medicaid |
$51.58
|
| Rate for Payer: Kentucky WC Medicaid |
$52.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$52.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
TELEPH E&M BY PHYS 21-30 MIN
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
51000163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$117.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$124.50
|
| Rate for Payer: First Health Commercial |
$142.50
|
| Rate for Payer: Humana Commercial |
$127.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$123.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$110.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$132.00
|
| Rate for Payer: Ohio Health Group HMO |
$112.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$30.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
TELEPORT 2.0F 135CM
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
TELEPORT 2.0F 135CM
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
TELEPORT CONTROL 2.1F 135CM
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
TELEPORT CONTROL 2.1F 135CM
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
TELESCOPE GUIDE EXTENSION 6F
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
TELESCOPE GUIDE EXTENSION 6F
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
TELETHERAPY COMPLEX
|
Professional
|
Both
|
$1,266.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
33300009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$1,266.00 |
| Rate for Payer: Anthem Medicaid |
$216.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,266.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$449.82
|
| Rate for Payer: Humana Medicaid |
$216.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.17
|
| Rate for Payer: Molina Healthcare Passport |
$216.83
|
| Rate for Payer: Multiplan PHCS |
$759.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$886.20
|
| Rate for Payer: UHCCP Medicaid |
$443.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.00
|
|
|
TELETHERAPY COMPLEX
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
33300009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.58 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$987.48
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$1,050.78
|
| Rate for Payer: First Health Commercial |
$1,202.70
|
| Rate for Payer: Humana Commercial |
$1,076.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,038.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$934.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$379.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,114.08
|
| Rate for Payer: Ohio Health Group HMO |
$949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.46
|
| Rate for Payer: PHCS Commercial |
$1,215.36
|
| Rate for Payer: United Healthcare All Payer |
$1,114.08
|
|
|
TELETHERAPY COMPLEX
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
33300009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$164.58 |
| Max. Negotiated Rate |
$1,215.36 |
| Rate for Payer: Aetna Commercial |
$974.82
|
| Rate for Payer: Anthem Medicaid |
$435.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$987.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cash Price |
$633.00
|
| Rate for Payer: Cigna Commercial |
$1,050.78
|
| Rate for Payer: First Health Commercial |
$1,202.70
|
| Rate for Payer: Humana Commercial |
$1,076.10
|
| Rate for Payer: Humana KY Medicaid |
$435.38
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$439.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,038.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$934.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$444.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,114.08
|
| Rate for Payer: Ohio Health Group HMO |
$949.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$253.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$164.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$392.46
|
| Rate for Payer: PHCS Commercial |
$1,215.36
|
| Rate for Payer: United Healthcare All Payer |
$1,114.08
|
|
|
TELETHERAPY COMPLEX(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
333P0009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$449.82 |
| Rate for Payer: Anthem Medicaid |
$216.83
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$449.82
|
| Rate for Payer: Humana Medicaid |
$216.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$187.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.17
|
| Rate for Payer: Molina Healthcare Passport |
$216.83
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.00
|
|
|
TELETHERAPY COMPLEX(T
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
333T0009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$743.82
|
| Rate for Payer: Anthem Medicaid |
$332.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$753.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$801.78
|
| Rate for Payer: First Health Commercial |
$917.70
|
| Rate for Payer: Humana Commercial |
$821.10
|
| Rate for Payer: Humana KY Medicaid |
$332.21
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$335.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$338.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.08
|
| Rate for Payer: Ohio Health Group HMO |
$724.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$927.36
|
| Rate for Payer: United Healthcare All Payer |
$850.08
|
|
|
TELETHERAPY COMPLEX(T
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
333T0009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$927.36 |
| Rate for Payer: Aetna Commercial |
$743.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$753.48
|
| Rate for Payer: Cash Price |
$483.00
|
| Rate for Payer: Cigna Commercial |
$801.78
|
| Rate for Payer: First Health Commercial |
$917.70
|
| Rate for Payer: Humana Commercial |
$821.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$792.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$850.08
|
| Rate for Payer: Ohio Health Group HMO |
$724.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$193.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$125.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$299.46
|
| Rate for Payer: PHCS Commercial |
$927.36
|
| Rate for Payer: United Healthcare All Payer |
$850.08
|
|
|
TELETHX ISODOSE PLAN SIMPLE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 77306
|
| Hospital Charge Code |
33300008
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
TELETHX ISODOSE PLAN SIMPLE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 77306
|
| Hospital Charge Code |
33300008
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
TELETHX ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 77306
|
| Hospital Charge Code |
33300008
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Anthem Medicaid |
$110.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$560.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$229.38
|
| Rate for Payer: Humana Medicaid |
$110.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.67
|
| Rate for Payer: Molina Healthcare Passport |
$110.46
|
| Rate for Payer: Multiplan PHCS |
$336.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$392.00
|
| Rate for Payer: UHCCP Medicaid |
$196.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.56
|
|
|
TELETHX ISODOSE PLAN SIMPLE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77306
|
| Hospital Charge Code |
333P0008
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$229.38 |
| Rate for Payer: Anthem Medicaid |
$110.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$229.38
|
| Rate for Payer: Humana Medicaid |
$110.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.67
|
| Rate for Payer: Molina Healthcare Passport |
$110.46
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.56
|
|
|
TELETHX ISODOSE PLAN SIMPLE(T
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS 77306
|
| Hospital Charge Code |
333T0008
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$53.30 |
| Max. Negotiated Rate |
$447.33 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Anthem Medicaid |
$141.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$319.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cash Price |
$205.00
|
| Rate for Payer: Cigna Commercial |
$340.30
|
| Rate for Payer: First Health Commercial |
$389.50
|
| Rate for Payer: Humana Commercial |
$348.50
|
| Rate for Payer: Humana KY Medicaid |
$141.00
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$142.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$336.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$302.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$143.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$360.80
|
| Rate for Payer: Ohio Health Group HMO |
$307.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$82.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$53.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$127.10
|
| Rate for Payer: PHCS Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Payer |
$360.80
|
|
