|
EST PT HIGH LEVEL 5
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
EST PT HIGH LEVEL 5
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem Medicaid |
$207.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Humana KY Medicaid |
$207.03
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$209.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$211.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
EST PT HIGH LEVEL 5
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
EST PT HIGH LEVEL 5
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
51000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.60 |
| Max. Negotiated Rate |
$577.92 |
| Rate for Payer: Aetna Commercial |
$463.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$469.56
|
| Rate for Payer: Cash Price |
$301.00
|
| Rate for Payer: Cigna Commercial |
$499.66
|
| Rate for Payer: First Health Commercial |
$571.90
|
| Rate for Payer: Humana Commercial |
$511.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$493.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$444.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$180.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$529.76
|
| Rate for Payer: Ohio Health Group HMO |
$451.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$481.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$523.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$415.38
|
| Rate for Payer: PHCS Commercial |
$577.92
|
| Rate for Payer: United Healthcare All Payer |
$529.76
|
|
|
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 |
$184.70 |
| Rate for Payer: Aetna Commercial |
$155.95
|
| Rate for Payer: Ambetter Exchange |
$135.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$73.54
|
| Rate for Payer: Anthem Medicaid |
$98.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$135.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$135.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$162.37
|
| 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 |
$98.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.06
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$135.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$135.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.36
|
| Rate for Payer: Molina Healthcare Passport |
$98.39
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.90
|
| 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 |
$99.37
|
| Rate for Payer: Wellcare Medicare Advantage |
$135.31
|
|
|
EST PT HIGH LEVEL 5(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
510T0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
EST PT HIGH LEVEL 5(T
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
EST PT HIGH LEVEL 5(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS 99215
|
| Hospital Charge Code |
510T0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.60 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
EST PT HIGH LEVEL 5(T
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$385.92 |
| Rate for Payer: Aetna Commercial |
$309.54
|
| Rate for Payer: Anthem Medicaid |
$138.25
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$313.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$333.66
|
| Rate for Payer: First Health Commercial |
$381.90
|
| Rate for Payer: Humana Commercial |
$341.70
|
| Rate for Payer: Humana KY Medicaid |
$138.25
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$139.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$329.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$296.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$141.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$353.76
|
| Rate for Payer: Ohio Health Group HMO |
$301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$321.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$349.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.38
|
| Rate for Payer: PHCS Commercial |
$385.92
|
| Rate for Payer: United Healthcare All Payer |
$353.76
|
|
|
EST PT LOW LEVEL 1
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$13.74
|
| Rate for Payer: Ambetter Exchange |
$8.22
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$5.88
|
| Rate for Payer: Anthem Medicaid |
$16.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$8.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$8.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.86
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$29.84
|
| Rate for Payer: Healthspan PPO |
$21.35
|
| Rate for Payer: Humana Medicaid |
$16.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$12.30
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$8.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$17.32
|
| Rate for Payer: Molina Healthcare Passport |
$16.98
|
| Rate for Payer: Multiplan PHCS |
$147.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10.69
|
| Rate for Payer: UHCCP Medicaid |
$6.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$17.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$8.22
|
|
|
EST PT LOW LEVEL 1
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.26 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
51000006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1(T
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1(T
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.26 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1(T
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
510T0006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 1(T
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
510T0006
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna Commercial |
$188.65
|
| Rate for Payer: Anthem Medicaid |
$84.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$191.10
|
| Rate for Payer: Cash Price |
$122.50
|
| Rate for Payer: Cigna Commercial |
$203.35
|
| Rate for Payer: First Health Commercial |
$232.75
|
| Rate for Payer: Humana Commercial |
$208.25
|
| Rate for Payer: Humana KY Medicaid |
$84.26
|
| Rate for Payer: Kentucky WC Medicaid |
$85.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$200.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$180.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$73.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$215.60
|
| Rate for Payer: Ohio Health Group HMO |
$183.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$213.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$169.05
|
| Rate for Payer: PHCS Commercial |
$235.20
|
| Rate for Payer: United Healthcare All Payer |
$215.60
|
|
|
EST PT LOW LEVEL 2
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$210.60 |
| Rate for Payer: Aetna Commercial |
$36.67
|
| Rate for Payer: Ambetter Exchange |
$33.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.34
|
| Rate for Payer: Anthem Medicaid |
$31.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$55.08
|
| Rate for Payer: Healthspan PPO |
$42.78
|
| Rate for Payer: Humana Medicaid |
$31.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.70
|
| Rate for Payer: Molina Healthcare Passport |
$31.08
|
| Rate for Payer: Multiplan PHCS |
$210.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.09
|
| 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 |
$31.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.15
|
|
|
EST PT LOW LEVEL 2
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem Medicaid |
$120.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Humana KY Medicaid |
$120.71
|
| Rate for Payer: Kentucky WC Medicaid |
$121.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
EST PT LOW LEVEL 2
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
EST PT LOW LEVEL 2
|
Facility
|
IP
|
$351.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.30 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
EST PT LOW LEVEL 2
|
Facility
|
OP
|
$351.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
51000007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$336.96 |
| Rate for Payer: Aetna Commercial |
$270.27
|
| Rate for Payer: Anthem Medicaid |
$120.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$273.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.74
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cigna Commercial |
$291.33
|
| Rate for Payer: First Health Commercial |
$333.45
|
| Rate for Payer: Humana Commercial |
$298.35
|
| Rate for Payer: Humana KY Medicaid |
$120.71
|
| Rate for Payer: Humana Medicare Advantage |
$119.07
|
| Rate for Payer: Kentucky WC Medicaid |
$121.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$287.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$308.88
|
| Rate for Payer: Ohio Health Group HMO |
$263.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$305.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.19
|
| Rate for Payer: PHCS Commercial |
$336.96
|
| Rate for Payer: United Healthcare All Payer |
$308.88
|
|
|
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 |
$55.08 |
| Rate for Payer: Aetna Commercial |
$36.67
|
| Rate for Payer: Ambetter Exchange |
$33.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.34
|
| Rate for Payer: Anthem Medicaid |
$31.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.78
|
| 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 |
$31.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$34.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$31.70
|
| Rate for Payer: Molina Healthcare Passport |
$31.08
|
| Rate for Payer: Multiplan PHCS |
$45.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.09
|
| 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 |
$31.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.15
|
|
|
EST PT LOW LEVEL 2(T
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS G0463
|
| Hospital Charge Code |
510T0007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$215.28
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
