|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem Medicaid |
$751.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Humana KY Medicaid |
$751.08
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$758.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.04
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$283.92 |
| Max. Negotiated Rate |
$2,096.64 |
| Rate for Payer: Aetna Commercial |
$1,681.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,703.52
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$1,812.72
|
| Rate for Payer: First Health Commercial |
$2,074.80
|
| Rate for Payer: Humana Commercial |
$1,856.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.04
|
| Rate for Payer: PHCS Commercial |
$2,096.64
|
| Rate for Payer: United Healthcare All Payer |
$1,921.92
|
|
|
NRV CNDJ TEST 11-12 STUDIES
|
Professional
|
Both
|
$2,184.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
92200016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$183.91 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: Anthem Medicaid |
$206.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,184.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cash Price |
$1,092.00
|
| Rate for Payer: Cigna Commercial |
$447.74
|
| Rate for Payer: Healthspan PPO |
$260.13
|
| Rate for Payer: Humana Medicaid |
$206.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.61
|
| Rate for Payer: Molina Healthcare Passport |
$206.48
|
| Rate for Payer: Multiplan PHCS |
$1,310.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,528.80
|
| Rate for Payer: UHCCP Medicaid |
$764.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.54
|
|
|
NRV CNDJ TEST 11-12 STUDIES(P
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
922P0016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$447.74 |
| Rate for Payer: Anthem Medicaid |
$206.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$224.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cigna Commercial |
$447.74
|
| Rate for Payer: Healthspan PPO |
$260.13
|
| Rate for Payer: Humana Medicaid |
$206.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$183.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$210.61
|
| Rate for Payer: Molina Healthcare Passport |
$206.48
|
| Rate for Payer: Multiplan PHCS |
$134.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$156.80
|
| Rate for Payer: UHCCP Medicaid |
$78.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$208.54
|
|
|
NRV CNDJ TEST 11-12 STUDIES(T
|
Facility
|
IP
|
$1,960.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
922T0016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,881.60 |
| Rate for Payer: Aetna Commercial |
$1,509.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.80
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cigna Commercial |
$1,626.80
|
| Rate for Payer: First Health Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial |
$1,666.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.60
|
| Rate for Payer: PHCS Commercial |
$1,881.60
|
| Rate for Payer: United Healthcare All Payer |
$1,724.80
|
|
|
NRV CNDJ TEST 11-12 STUDIES(T
|
Facility
|
OP
|
$1,960.00
|
|
|
Service Code
|
HCPCS 95912
|
| Hospital Charge Code |
922T0016
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$1,881.60 |
| Rate for Payer: Aetna Commercial |
$1,509.20
|
| Rate for Payer: Anthem Medicaid |
$674.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cigna Commercial |
$1,626.80
|
| Rate for Payer: First Health Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial |
$1,666.00
|
| Rate for Payer: Humana KY Medicaid |
$674.04
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$680.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$687.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,470.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.60
|
| Rate for Payer: PHCS Commercial |
$1,881.60
|
| Rate for Payer: United Healthcare All Payer |
$1,724.80
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
IP
|
$2,930.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$380.90 |
| Max. Negotiated Rate |
$2,812.80 |
| Rate for Payer: Aetna Commercial |
$2,256.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,285.40
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cigna Commercial |
$2,431.90
|
| Rate for Payer: First Health Commercial |
$2,783.50
|
| Rate for Payer: Humana Commercial |
$2,490.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,402.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,162.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$879.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,578.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,197.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$586.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$908.30
|
| Rate for Payer: PHCS Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Payer |
$2,578.40
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Facility
|
OP
|
$2,930.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$380.90 |
| Max. Negotiated Rate |
$2,812.80 |
| Rate for Payer: Aetna Commercial |
$2,256.10
|
| Rate for Payer: Anthem Medicaid |
$1,007.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,285.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cigna Commercial |
$2,431.90
|
| Rate for Payer: First Health Commercial |
$2,783.50
|
| Rate for Payer: Humana Commercial |
$2,490.50
|
| Rate for Payer: Humana KY Medicaid |
$1,007.63
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,017.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,402.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,162.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,027.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,578.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,197.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$586.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$380.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$908.30
|
| Rate for Payer: PHCS Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Payer |
$2,578.40
|
|
|
NRV CNDJ TEST 13/> STUDIES
|
Professional
|
Both
|
$2,930.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
92200017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$2,930.00 |
| Rate for Payer: Anthem Medicaid |
$239.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,930.00
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cash Price |
$1,465.00
|
| Rate for Payer: Cigna Commercial |
$519.29
|
| Rate for Payer: Healthspan PPO |
$301.40
|
| Rate for Payer: Humana Medicaid |
$239.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.09
|
| Rate for Payer: Molina Healthcare Passport |
$239.30
|
| Rate for Payer: Multiplan PHCS |
$1,758.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,051.00
|
| Rate for Payer: UHCCP Medicaid |
$1,025.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.69
|
|
|
NRV CNDJ TEST 13/> STUDIES(P
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
922P0017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$519.29 |
| Rate for Payer: Anthem Medicaid |
$239.30
|
| Rate for Payer: Buckeye Medicare Advantage |
$265.00
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cigna Commercial |
$519.29
|
| Rate for Payer: Healthspan PPO |
$301.40
|
| Rate for Payer: Humana Medicaid |
$239.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$218.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$244.09
|
| Rate for Payer: Molina Healthcare Passport |
$239.30
|
| Rate for Payer: Multiplan PHCS |
$159.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.50
|
| Rate for Payer: UHCCP Medicaid |
$92.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$241.69
|
|
|
NRV CNDJ TEST 13/> STUDIES(T
|
Facility
|
OP
|
$2,665.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
922T0017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$346.45 |
| Max. Negotiated Rate |
$2,558.40 |
| Rate for Payer: Aetna Commercial |
$2,052.05
|
| Rate for Payer: Anthem Medicaid |
$916.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,078.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$1,332.50
|
| Rate for Payer: Cash Price |
$1,332.50
|
| Rate for Payer: Cigna Commercial |
$2,211.95
|
| Rate for Payer: First Health Commercial |
$2,531.75
|
| Rate for Payer: Humana Commercial |
$2,265.25
|
| Rate for Payer: Humana KY Medicaid |
$916.49
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$925.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,185.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,966.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$934.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,345.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,998.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.15
|
| Rate for Payer: PHCS Commercial |
$2,558.40
|
| Rate for Payer: United Healthcare All Payer |
$2,345.20
|
|
|
NRV CNDJ TEST 13/> STUDIES(T
|
Facility
|
IP
|
$2,665.00
|
|
|
Service Code
|
HCPCS 95913
|
| Hospital Charge Code |
922T0017
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$346.45 |
| Max. Negotiated Rate |
$2,558.40 |
| Rate for Payer: Aetna Commercial |
$2,052.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,078.70
|
| Rate for Payer: Cash Price |
$1,332.50
|
| Rate for Payer: Cigna Commercial |
$2,211.95
|
| Rate for Payer: First Health Commercial |
$2,531.75
|
| Rate for Payer: Humana Commercial |
$2,265.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,185.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,966.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$799.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,345.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,998.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$533.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$346.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.15
|
| Rate for Payer: PHCS Commercial |
$2,558.40
|
| Rate for Payer: United Healthcare All Payer |
$2,345.20
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$1,426.00 |
| Rate for Payer: Anthem Medicaid |
$145.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,426.00
|
| Rate for Payer: Cash Price |
$713.00
|
| Rate for Payer: Cash Price |
$713.00
|
| Rate for Payer: Cigna Commercial |
$315.34
|
| Rate for Payer: Healthspan PPO |
$183.12
|
| Rate for Payer: Humana Medicaid |
$145.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.23
|
| Rate for Payer: Molina Healthcare Passport |
$145.32
|
| Rate for Payer: Multiplan PHCS |
$855.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$998.20
|
| Rate for Payer: UHCCP Medicaid |
$499.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.77
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
IP
|
$1,426.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$185.38 |
| Max. Negotiated Rate |
$1,368.96 |
| Rate for Payer: Aetna Commercial |
$1,098.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,112.28
|
| Rate for Payer: Cash Price |
$713.00
|
| Rate for Payer: Cigna Commercial |
$1,183.58
|
| Rate for Payer: First Health Commercial |
$1,354.70
|
| Rate for Payer: Humana Commercial |
$1,212.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,169.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,052.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,069.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$442.06
|
| Rate for Payer: PHCS Commercial |
$1,368.96
|
| Rate for Payer: United Healthcare All Payer |
$1,254.88
|
|
|
NRV CNDJ TEST 7-8 STUDIES
|
Facility
|
OP
|
$1,426.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
92200014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$185.38 |
| Max. Negotiated Rate |
$1,368.96 |
| Rate for Payer: Aetna Commercial |
$1,098.02
|
| Rate for Payer: Anthem Medicaid |
$490.40
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,112.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$713.00
|
| Rate for Payer: Cash Price |
$713.00
|
| Rate for Payer: Cigna Commercial |
$1,183.58
|
| Rate for Payer: First Health Commercial |
$1,354.70
|
| Rate for Payer: Humana Commercial |
$1,212.10
|
| Rate for Payer: Humana KY Medicaid |
$490.40
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$495.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,169.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,052.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$500.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,254.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,069.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$285.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$185.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$442.06
|
| Rate for Payer: PHCS Commercial |
$1,368.96
|
| Rate for Payer: United Healthcare All Payer |
$1,254.88
|
|
|
NRV CNDJ TEST 7-8 STUDIES(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
922P0014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$315.34 |
| Rate for Payer: Anthem Medicaid |
$145.32
|
| 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 |
$315.34
|
| Rate for Payer: Healthspan PPO |
$183.12
|
| Rate for Payer: Humana Medicaid |
$145.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$148.23
|
| Rate for Payer: Molina Healthcare Passport |
$145.32
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.77
|
|
|
NRV CNDJ TEST 7-8 STUDIES(T
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
922T0014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$1,224.96 |
| Rate for Payer: Aetna Commercial |
$982.52
|
| Rate for Payer: Anthem Medicaid |
$438.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna Commercial |
$1,059.08
|
| Rate for Payer: First Health Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial |
$1,084.60
|
| Rate for Payer: Humana KY Medicaid |
$438.82
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,046.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$941.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.56
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
|
NRV CNDJ TEST 7-8 STUDIES(T
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
922T0014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$1,224.96 |
| Rate for Payer: Aetna Commercial |
$982.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna Commercial |
$1,059.08
|
| Rate for Payer: First Health Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial |
$1,084.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,046.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$941.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.56
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
IP
|
$1,842.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$239.46 |
| Max. Negotiated Rate |
$1,768.32 |
| Rate for Payer: Aetna Commercial |
$1,418.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,436.76
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$1,528.86
|
| Rate for Payer: First Health Commercial |
$1,749.90
|
| Rate for Payer: Humana Commercial |
$1,565.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,510.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,359.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,620.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,381.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.02
|
| Rate for Payer: PHCS Commercial |
$1,768.32
|
| Rate for Payer: United Healthcare All Payer |
$1,620.96
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
OP
|
$1,842.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$239.46 |
| Max. Negotiated Rate |
$1,768.32 |
| Rate for Payer: Aetna Commercial |
$1,418.34
|
| Rate for Payer: Anthem Medicaid |
$633.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,436.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$1,528.86
|
| Rate for Payer: First Health Commercial |
$1,749.90
|
| Rate for Payer: Humana Commercial |
$1,565.70
|
| Rate for Payer: Humana KY Medicaid |
$633.46
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$639.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,510.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,359.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,620.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,381.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.02
|
| Rate for Payer: PHCS Commercial |
$1,768.32
|
| Rate for Payer: United Healthcare All Payer |
$1,620.96
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$1,842.00 |
| Rate for Payer: Anthem Medicaid |
$175.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,842.00
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cash Price |
$921.00
|
| Rate for Payer: Cigna Commercial |
$382.10
|
| Rate for Payer: Healthspan PPO |
$221.62
|
| Rate for Payer: Humana Medicaid |
$175.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.42
|
| Rate for Payer: Molina Healthcare Passport |
$175.90
|
| Rate for Payer: Multiplan PHCS |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,289.40
|
| Rate for Payer: UHCCP Medicaid |
$644.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.66
|
|
|
NRV CNDJ TEST 9-10 STUDIES(P
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
922P0015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$382.10 |
| Rate for Payer: Anthem Medicaid |
$175.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$187.00
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cash Price |
$93.50
|
| Rate for Payer: Cigna Commercial |
$382.10
|
| Rate for Payer: Healthspan PPO |
$221.62
|
| Rate for Payer: Humana Medicaid |
$175.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.25
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.42
|
| Rate for Payer: Molina Healthcare Passport |
$175.90
|
| Rate for Payer: Multiplan PHCS |
$112.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$130.90
|
| Rate for Payer: UHCCP Medicaid |
$65.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.66
|
|
|
NRV CNDJ TEST 9-10 STUDIES(T
|
Facility
|
OP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
922T0015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$215.15 |
| Max. Negotiated Rate |
$1,588.80 |
| Rate for Payer: Aetna Commercial |
$1,274.35
|
| Rate for Payer: Anthem Medicaid |
$569.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$463.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$648.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$625.71
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$1,373.65
|
| Rate for Payer: First Health Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial |
$1,406.75
|
| Rate for Payer: Humana KY Medicaid |
$569.15
|
| Rate for Payer: Humana Medicare Advantage |
$463.49
|
| Rate for Payer: Kentucky WC Medicaid |
$574.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,357.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,221.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$580.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,456.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,241.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.05
|
| Rate for Payer: PHCS Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Payer |
$1,456.40
|
|
|
NRV CNDJ TEST 9-10 STUDIES(T
|
Facility
|
IP
|
$1,655.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
922T0015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$215.15 |
| Max. Negotiated Rate |
$1,588.80 |
| Rate for Payer: Aetna Commercial |
$1,274.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.90
|
| Rate for Payer: Cash Price |
$827.50
|
| Rate for Payer: Cigna Commercial |
$1,373.65
|
| Rate for Payer: First Health Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial |
$1,406.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,357.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,221.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,456.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,241.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$331.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$513.05
|
| Rate for Payer: PHCS Commercial |
$1,588.80
|
| Rate for Payer: United Healthcare All Payer |
$1,456.40
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
92200012
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$683.52 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem Medicaid |
$244.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$590.96
|
| Rate for Payer: First Health Commercial |
$676.40
|
| Rate for Payer: Humana Commercial |
$605.20
|
| Rate for Payer: Humana KY Medicaid |
$244.86
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$247.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$583.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$525.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$249.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$626.56
|
| Rate for Payer: Ohio Health Group HMO |
$534.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$142.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$92.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$220.72
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
