|
TELEH NURSING FAC CARE SUBSQNT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 99310
|
| Hospital Charge Code |
51000178
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$187.39 |
| Rate for Payer: Aetna Commercial |
$187.39
|
| Rate for Payer: Ambetter Exchange |
$144.11
|
| Rate for Payer: Anthem Medicaid |
$74.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$144.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$144.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$172.93
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$140.89
|
| Rate for Payer: Healthspan PPO |
$139.30
|
| Rate for Payer: Humana Medicaid |
$74.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$172.41
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$144.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$75.98
|
| Rate for Payer: Molina Healthcare Passport |
$74.49
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$187.34
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.23
|
| Rate for Payer: Wellcare Medicare Advantage |
$144.11
|
|
|
TELEH PREVENT VISIT - 12-17 YR
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 99394
|
| Hospital Charge Code |
51000175
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.91 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$42.91
|
| Rate for Payer: Anthem Medicaid |
$89.90
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$134.42
|
| Rate for Payer: Healthspan PPO |
$111.74
|
| Rate for Payer: Humana Medicaid |
$89.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.70
|
| Rate for Payer: Molina Healthcare Passport |
$89.90
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$45.06
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.80
|
|
|
TELEH PREVENT VISIT - 18-39 YR
|
Professional
|
Both
|
$377.50
|
|
|
Service Code
|
HCPCS 99395
|
| Hospital Charge Code |
51000176
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.13 |
| Max. Negotiated Rate |
$264.25 |
| Rate for Payer: Aetna Commercial |
$107.24
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$44.13
|
| Rate for Payer: Anthem Medicaid |
$84.80
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cash Price |
$188.75
|
| Rate for Payer: Cigna Commercial |
$135.52
|
| Rate for Payer: Healthspan PPO |
$111.74
|
| Rate for Payer: Humana Medicaid |
$84.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$90.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$86.50
|
| Rate for Payer: Molina Healthcare Passport |
$84.80
|
| Rate for Payer: Multiplan PHCS |
$226.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$264.25
|
| Rate for Payer: UHCCP Medicaid |
$46.34
|
| Rate for Payer: United Healthcare Non-Options |
$73.86
|
| Rate for Payer: United Healthcare Options |
$60.46
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$85.65
|
|
|
TELEH PSYCHOTHERAPY 30MIN W/PT
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 90832
|
| Hospital Charge Code |
90000025
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$35.58 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$90.22
|
| Rate for Payer: Ambetter Exchange |
$68.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$35.58
|
| Rate for Payer: Anthem Medicaid |
$47.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$68.28
|
| Rate for Payer: Buckeye Medicare Advantage |
$68.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$81.94
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$92.42
|
| Rate for Payer: Healthspan PPO |
$80.30
|
| Rate for Payer: Humana Medicaid |
$47.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.56
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$68.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.28
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$48.36
|
| Rate for Payer: Molina Healthcare Passport |
$47.41
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$88.76
|
| Rate for Payer: UHCCP Medicaid |
$37.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$68.28
|
|
|
TELEH SMOKE TOBAC CESS 4-10MIN
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200016
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem Medicaid |
$22.70
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Humana KY Medicaid |
$22.70
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$22.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
TELEH SMOKE TOBAC CESS 4-10MIN
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200016
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna Commercial |
$18.31
|
| Rate for Payer: Ambetter Exchange |
$11.08
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$7.72
|
| Rate for Payer: Anthem Medicaid |
$11.34
|
| Rate for Payer: Buckeye Individual/Medicaid |
$11.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$11.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$13.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$18.48
|
| Rate for Payer: Healthspan PPO |
$15.97
|
| Rate for Payer: Humana Medicaid |
$11.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$16.22
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$11.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$11.57
|
| Rate for Payer: Molina Healthcare Passport |
$11.34
|
| Rate for Payer: Multiplan PHCS |
$39.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$14.40
|
| Rate for Payer: UHCCP Medicaid |
$8.11
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$11.08
|
|
|
TELEH SMOKE TOBAC CESS 4-10MIN
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
94200016
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: Aetna Commercial |
$50.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$51.48
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$54.78
|
| Rate for Payer: First Health Commercial |
$62.70
|
| Rate for Payer: Humana Commercial |
$56.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$48.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.08
|
| Rate for Payer: Ohio Health Group HMO |
$49.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$52.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$45.54
|
| Rate for Payer: PHCS Commercial |
$63.36
|
| Rate for Payer: United Healthcare All Payer |
$58.08
|
|
|
TELEPH E&M BY PHY/QHP 5-10 MIN
|
Facility
|
IP
|
$80.00
|
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.00 |
| 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 |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| 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
|
Facility
|
OP
|
$80.00
|
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| 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: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| 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: Molina Healthcare Medicaid |
$28.06
|
| 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 |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| 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
|
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
|
|
TELEPH E&M BY PHYS 11-20 MIN
|
Professional
|
Both
|
$115.00
|
|
| Hospital Charge Code |
51000162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Multiplan PHCS |
$69.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$40.25
|
|
|
TELEPH E&M BY PHYS 11-20 MIN
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
51000162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.50 |
| 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 |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| 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
|
IP
|
$115.00
|
|
| Hospital Charge Code |
51000162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.50 |
| 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 |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| 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
|
|
| Hospital Charge Code |
51000163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Cash Price |
$75.00
|
| 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
|
|
|
TELEPH E&M BY PHYS 21-30 MIN
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
51000163
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$115.50
|
| Rate for Payer: Anthem Medicaid |
$51.59
|
| 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 |
$51.59
|
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| 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 |
$45.00 |
| 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 |
$120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$103.50
|
| Rate for Payer: PHCS Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Payer |
$132.00
|
|
|
TELEPORT 2.0F 135CM
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
TELEPORT 2.0F 135CM
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
TELEPORT CONTROL 2.1F 135CM
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
TELEPORT CONTROL 2.1F 135CM
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
TELESCOPE GUIDE EXTENSION 6F
|
Facility
|
OP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
TELESCOPE GUIDE EXTENSION 6F
|
Facility
|
IP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
TELETHERAPY COMPLEX
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
33300009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$1,275.84 |
| Rate for Payer: Aetna Commercial |
$1,023.33
|
| Rate for Payer: Anthem Medicaid |
$457.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$338.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,036.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$473.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$456.62
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$1,103.07
|
| Rate for Payer: First Health Commercial |
$1,262.55
|
| Rate for Payer: Humana Commercial |
$1,129.65
|
| Rate for Payer: Humana KY Medicaid |
$457.04
|
| Rate for Payer: Humana Medicare Advantage |
$338.24
|
| Rate for Payer: Kentucky WC Medicaid |
$461.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,089.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$980.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,169.52
|
| Rate for Payer: Ohio Health Group HMO |
$996.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,156.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.01
|
| Rate for Payer: PHCS Commercial |
$1,275.84
|
| Rate for Payer: United Healthcare All Payer |
$1,169.52
|
|
|
TELETHERAPY COMPLEX
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
33300009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$398.70 |
| Max. Negotiated Rate |
$1,275.84 |
| Rate for Payer: Aetna Commercial |
$1,023.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,036.62
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cigna Commercial |
$1,103.07
|
| Rate for Payer: First Health Commercial |
$1,262.55
|
| Rate for Payer: Humana Commercial |
$1,129.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,089.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$980.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$398.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,169.52
|
| Rate for Payer: Ohio Health Group HMO |
$996.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,156.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$917.01
|
| Rate for Payer: PHCS Commercial |
$1,275.84
|
| Rate for Payer: United Healthcare All Payer |
$1,169.52
|
|
|
TELETHERAPY COMPLEX
|
Professional
|
Both
|
$1,329.00
|
|
|
Service Code
|
HCPCS 77307
|
| Hospital Charge Code |
33300009
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Ambetter Exchange |
$267.16
|
| Rate for Payer: Anthem Medicaid |
$216.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$267.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$267.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$320.59
|
| Rate for Payer: Cash Price |
$664.50
|
| Rate for Payer: Cash Price |
$664.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$267.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$267.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$221.17
|
| Rate for Payer: Molina Healthcare Passport |
$216.83
|
| Rate for Payer: Multiplan PHCS |
$797.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$347.31
|
| Rate for Payer: UHCCP Medicaid |
$465.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$219.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$267.16
|
|
