|
EST PT HIGH LEVEL 4(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99214
|
| Hospital Charge Code |
510P0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$109.62
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$49.49
|
| Rate for Payer: Anthem Medicaid |
$61.98
|
| 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 |
$136.31
|
| Rate for Payer: Healthspan PPO |
$106.96
|
| Rate for Payer: Humana Medicaid |
$61.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$89.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$63.22
|
| Rate for Payer: Molina Healthcare Passport |
$61.98
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$51.96
|
| Rate for Payer: United Healthcare Non-Options |
$75.50
|
| Rate for Payer: United Healthcare Options |
$61.81
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$62.60
|
|
|
EST PT HIGH LEVEL 4(T
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$249.48
|
| Rate for Payer: Anthem Medicaid |
$111.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$268.92
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Humana Commercial |
$275.40
|
| Rate for Payer: Humana KY Medicaid |
$111.42
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$112.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$113.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.12
|
| Rate for Payer: Ohio Health Group HMO |
$243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.44
|
| Rate for Payer: PHCS Commercial |
$311.04
|
| Rate for Payer: United Healthcare All Payer |
$285.12
|
|
|
EST PT HIGH LEVEL 4(T
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$249.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$252.72
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$268.92
|
| Rate for Payer: First Health Commercial |
$307.80
|
| Rate for Payer: Humana Commercial |
$275.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$265.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$239.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$285.12
|
| Rate for Payer: Ohio Health Group HMO |
$243.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$42.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$100.44
|
| Rate for Payer: PHCS Commercial |
$311.04
|
| Rate for Payer: United Healthcare All Payer |
$285.12
|
|
|
EST PT HIGH LEVEL 5
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.21
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
EST PT HIGH LEVEL 5
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$591.00 |
| Rate for Payer: Aetna Commercial |
$155.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$87.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$591.00
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$184.70
|
| Rate for Payer: Healthspan PPO |
$144.98
|
| Rate for Payer: Humana Medicaid |
$87.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Molina Healthcare Passport |
$87.17
|
| Rate for Payer: Multiplan PHCS |
$354.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$413.70
|
| Rate for Payer: UHCCP Medicaid |
$77.22
|
| Rate for Payer: United Healthcare Non-Options |
$107.40
|
| Rate for Payer: United Healthcare Options |
$87.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.04
|
|
|
EST PT HIGH LEVEL 5
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.83 |
| Max. Negotiated Rate |
$567.36 |
| Rate for Payer: Aetna Commercial |
$455.07
|
| Rate for Payer: Anthem Medicaid |
$203.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$460.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$490.53
|
| Rate for Payer: First Health Commercial |
$561.45
|
| Rate for Payer: Humana Commercial |
$502.35
|
| Rate for Payer: Humana KY Medicaid |
$203.24
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$205.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$484.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$436.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$207.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$520.08
|
| Rate for Payer: Ohio Health Group HMO |
$443.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$118.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$76.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$183.21
|
| Rate for Payer: PHCS Commercial |
$567.36
|
| Rate for Payer: United Healthcare All Payer |
$520.08
|
|
|
EST PT HIGH LEVEL 5(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
510P0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.54 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$155.95
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$87.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$184.70
|
| Rate for Payer: Healthspan PPO |
$144.98
|
| Rate for Payer: Humana Medicaid |
$87.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$88.91
|
| Rate for Payer: Molina Healthcare Passport |
$87.17
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$77.22
|
| Rate for Payer: United Healthcare Non-Options |
$107.40
|
| Rate for Payer: United Healthcare Options |
$87.92
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$88.04
|
|
|
EST PT HIGH LEVEL 5(T
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EST PT HIGH LEVEL 5(T
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.83 |
| Max. Negotiated Rate |
$375.36 |
| Rate for Payer: Aetna Commercial |
$301.07
|
| Rate for Payer: Anthem Medicaid |
$134.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$304.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cash Price |
$195.50
|
| Rate for Payer: Cigna Commercial |
$324.53
|
| Rate for Payer: First Health Commercial |
$371.45
|
| Rate for Payer: Humana Commercial |
$332.35
|
| Rate for Payer: Humana KY Medicaid |
$134.46
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$135.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$320.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$288.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$137.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$344.08
|
| Rate for Payer: Ohio Health Group HMO |
$293.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$78.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$121.21
|
| Rate for Payer: PHCS Commercial |
$375.36
|
| Rate for Payer: United Healthcare All Payer |
$344.08
|
|
|
EST PT LOW LEVEL 1
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: Anthem Medicaid |
$81.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: First Health Commercial |
$226.10
|
| Rate for Payer: Humana Commercial |
$202.30
|
| Rate for Payer: Humana KY Medicaid |
$81.85
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$82.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$175.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$209.44
|
| Rate for Payer: Ohio Health Group HMO |
$178.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.78
|
| Rate for Payer: PHCS Commercial |
$228.48
|
| Rate for Payer: United Healthcare All Payer |
$209.44
|
|
|
EST PT LOW LEVEL 1
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.88
|
| Rate for Payer: Anthem Medicaid |
$7.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$238.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$29.84
|
| Rate for Payer: Healthspan PPO |
$21.35
|
| Rate for Payer: Humana Medicaid |
$7.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.30
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$7.63
|
| Rate for Payer: Molina Healthcare Passport |
$7.48
|
| Rate for Payer: Multiplan PHCS |
$142.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$166.60
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$7.55
|
|
|
EST PT LOW LEVEL 1
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.64
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: First Health Commercial |
$226.10
|
| Rate for Payer: Humana Commercial |
$202.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$175.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$209.44
|
| Rate for Payer: Ohio Health Group HMO |
$178.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.78
|
| Rate for Payer: PHCS Commercial |
$228.48
|
| Rate for Payer: United Healthcare All Payer |
$209.44
|
|
|
EST PT LOW LEVEL 1(T
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: Anthem Medicaid |
$81.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: First Health Commercial |
$226.10
|
| Rate for Payer: Humana Commercial |
$202.30
|
| Rate for Payer: Humana KY Medicaid |
$81.85
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$82.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$175.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$209.44
|
| Rate for Payer: Ohio Health Group HMO |
$178.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.78
|
| Rate for Payer: PHCS Commercial |
$228.48
|
| Rate for Payer: United Healthcare All Payer |
$209.44
|
|
|
EST PT LOW LEVEL 1(T
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$228.48 |
| Rate for Payer: Aetna Commercial |
$183.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$185.64
|
| Rate for Payer: Cash Price |
$119.00
|
| Rate for Payer: Cigna Commercial |
$197.54
|
| Rate for Payer: First Health Commercial |
$226.10
|
| Rate for Payer: Humana Commercial |
$202.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$195.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$175.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$71.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$209.44
|
| Rate for Payer: Ohio Health Group HMO |
$178.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$73.78
|
| Rate for Payer: PHCS Commercial |
$228.48
|
| Rate for Payer: United Healthcare All Payer |
$209.44
|
|
|
EST PT LOW LEVEL 2
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.54
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$102.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.33
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
EST PT LOW LEVEL 2
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Aetna Commercial |
$36.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.34
|
| Rate for Payer: Anthem Medicaid |
$20.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$343.00
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$55.08
|
| Rate for Payer: Healthspan PPO |
$42.78
|
| Rate for Payer: Humana Medicaid |
$20.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.82
|
| Rate for Payer: Molina Healthcare Passport |
$20.41
|
| Rate for Payer: Multiplan PHCS |
$205.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$240.10
|
| Rate for Payer: UHCCP Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Non-Options |
$25.26
|
| Rate for Payer: United Healthcare Options |
$20.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.61
|
|
|
EST PT LOW LEVEL 2
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: Aetna Commercial |
$264.11
|
| Rate for Payer: Anthem Medicaid |
$117.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$267.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cash Price |
$171.50
|
| Rate for Payer: Cigna Commercial |
$284.69
|
| Rate for Payer: First Health Commercial |
$325.85
|
| Rate for Payer: Humana Commercial |
$291.55
|
| Rate for Payer: Humana KY Medicaid |
$117.96
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$119.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$281.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$253.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$120.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$301.84
|
| Rate for Payer: Ohio Health Group HMO |
$257.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$68.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$44.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$106.33
|
| Rate for Payer: PHCS Commercial |
$329.28
|
| Rate for Payer: United Healthcare All Payer |
$301.84
|
|
|
EST PT LOW LEVEL 2(P
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
510P0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$36.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.34
|
| Rate for Payer: Anthem Medicaid |
$20.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$55.08
|
| Rate for Payer: Healthspan PPO |
$42.78
|
| Rate for Payer: Humana Medicaid |
$20.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$20.82
|
| Rate for Payer: Molina Healthcare Passport |
$20.41
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$52.50
|
| Rate for Payer: UHCCP Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Non-Options |
$25.26
|
| Rate for Payer: United Healthcare Options |
$20.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$20.61
|
|
|
EST PT LOW LEVEL 2(T
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$257.28 |
| Rate for Payer: Aetna Commercial |
$206.36
|
| Rate for Payer: Anthem Medicaid |
$92.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$222.44
|
| Rate for Payer: First Health Commercial |
$254.60
|
| Rate for Payer: Humana Commercial |
$227.80
|
| Rate for Payer: Humana KY Medicaid |
$92.17
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$93.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
| Rate for Payer: Ohio Health Group HMO |
$201.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.08
|
| Rate for Payer: PHCS Commercial |
$257.28
|
| Rate for Payer: United Healthcare All Payer |
$235.84
|
|
|
EST PT LOW LEVEL 2(T
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.84 |
| Max. Negotiated Rate |
$257.28 |
| Rate for Payer: Aetna Commercial |
$206.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$209.04
|
| Rate for Payer: Cash Price |
$134.00
|
| Rate for Payer: Cigna Commercial |
$222.44
|
| Rate for Payer: First Health Commercial |
$254.60
|
| Rate for Payer: Humana Commercial |
$227.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$219.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$197.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$80.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$235.84
|
| Rate for Payer: Ohio Health Group HMO |
$201.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$34.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$83.08
|
| Rate for Payer: PHCS Commercial |
$257.28
|
| Rate for Payer: United Healthcare All Payer |
$235.84
|
|
|
EST PT MID LEVEL 3
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$363.84 |
| Rate for Payer: Aetna Commercial |
$291.83
|
| Rate for Payer: Anthem Medicaid |
$130.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$295.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$160.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.32
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cigna Commercial |
$314.57
|
| Rate for Payer: First Health Commercial |
$360.05
|
| Rate for Payer: Humana Commercial |
$322.15
|
| Rate for Payer: Humana KY Medicaid |
$130.34
|
| Rate for Payer: Humana Medicare Advantage |
$114.31
|
| Rate for Payer: Kentucky WC Medicaid |
$131.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$310.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$279.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$132.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$333.52
|
| Rate for Payer: Ohio Health Group HMO |
$284.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.49
|
| Rate for Payer: PHCS Commercial |
$363.84
|
| Rate for Payer: United Healthcare All Payer |
$333.52
|
|
|
EST PT MID LEVEL 3
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$363.84 |
| Rate for Payer: Aetna Commercial |
$291.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$295.62
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cigna Commercial |
$314.57
|
| Rate for Payer: First Health Commercial |
$360.05
|
| Rate for Payer: Humana Commercial |
$322.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$310.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$279.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$333.52
|
| Rate for Payer: Ohio Health Group HMO |
$284.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$75.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$49.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$117.49
|
| Rate for Payer: PHCS Commercial |
$363.84
|
| Rate for Payer: United Healthcare All Payer |
$333.52
|
|
|
EST PT MID LEVEL 3
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$379.00 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.74
|
| Rate for Payer: Anthem Medicaid |
$40.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$379.00
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cigna Commercial |
$89.85
|
| Rate for Payer: Healthspan PPO |
$70.91
|
| Rate for Payer: Humana Medicaid |
$40.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.17
|
| Rate for Payer: Molina Healthcare Passport |
$40.36
|
| Rate for Payer: Multiplan PHCS |
$227.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$265.30
|
| Rate for Payer: UHCCP Medicaid |
$35.43
|
| Rate for Payer: United Healthcare Non-Options |
$48.74
|
| Rate for Payer: United Healthcare Options |
$39.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.76
|
|
|
EST PT MID LEVEL 3(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99213
|
| Hospital Charge Code |
510P0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$33.74
|
| Rate for Payer: Anthem Medicaid |
$40.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$89.85
|
| Rate for Payer: Healthspan PPO |
$70.91
|
| Rate for Payer: Humana Medicaid |
$40.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$65.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$41.17
|
| Rate for Payer: Molina Healthcare Passport |
$40.36
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.43
|
| Rate for Payer: United Healthcare Non-Options |
$48.74
|
| Rate for Payer: United Healthcare Options |
$39.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$40.76
|
|
|
EST PT MID LEVEL 3(T
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.27 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$214.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$217.62
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$231.57
|
| Rate for Payer: First Health Commercial |
$265.05
|
| Rate for Payer: Humana Commercial |
$237.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$228.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$205.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$83.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$245.52
|
| Rate for Payer: Ohio Health Group HMO |
$209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$55.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.49
|
| Rate for Payer: PHCS Commercial |
$267.84
|
| Rate for Payer: United Healthcare All Payer |
$245.52
|
|
