|
NEO-SYNEPHRINE 0.5% NASAL SPRY
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 225080547
|
| Hospital Charge Code |
25003731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Anthem Medicaid |
$0.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Cash Price |
$0.02
|
| Rate for Payer: Cigna Commercial |
$0.03
|
| Rate for Payer: First Health Commercial |
$0.04
|
| Rate for Payer: Humana Commercial |
$0.03
|
| Rate for Payer: Humana KY Medicaid |
$0.01
|
| Rate for Payer: Kentucky WC Medicaid |
$0.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.04
|
| Rate for Payer: Ohio Health Group HMO |
$0.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.03
|
| Rate for Payer: PHCS Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Payer |
$0.04
|
|
|
NEOSYNEPHRINE/PHENYLEP BOTTLE
|
Facility
|
OP
|
$183.50
|
|
|
Service Code
|
NDC 70756062925
|
| Hospital Charge Code |
25001060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna Commercial |
$141.29
|
| Rate for Payer: Anthem Medicaid |
$63.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.13
|
| Rate for Payer: Cash Price |
$91.75
|
| Rate for Payer: Cigna Commercial |
$152.31
|
| Rate for Payer: First Health Commercial |
$174.32
|
| Rate for Payer: Humana Commercial |
$155.97
|
| Rate for Payer: Humana KY Medicaid |
$63.11
|
| Rate for Payer: Kentucky WC Medicaid |
$63.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$64.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.48
|
| Rate for Payer: Ohio Health Group HMO |
$137.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.61
|
| Rate for Payer: PHCS Commercial |
$176.16
|
| Rate for Payer: United Healthcare All Payer |
$161.48
|
|
|
NEOSYNEPHRINE/PHENYLEP BOTTLE
|
Facility
|
IP
|
$183.50
|
|
|
Service Code
|
NDC 70756062925
|
| Hospital Charge Code |
25001060
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$176.16 |
| Rate for Payer: Aetna Commercial |
$141.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$143.13
|
| Rate for Payer: Cash Price |
$91.75
|
| Rate for Payer: Cigna Commercial |
$152.31
|
| Rate for Payer: First Health Commercial |
$174.32
|
| Rate for Payer: Humana Commercial |
$155.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$150.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$135.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$55.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$161.48
|
| Rate for Payer: Ohio Health Group HMO |
$137.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$146.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$159.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$126.61
|
| Rate for Payer: PHCS Commercial |
$176.16
|
| Rate for Payer: United Healthcare All Payer |
$161.48
|
|
|
NEPHR0MAX KIT
|
Facility
|
IP
|
$2,939.60
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.88 |
| Max. Negotiated Rate |
$2,822.02 |
| Rate for Payer: Aetna Commercial |
$2,263.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,292.89
|
| Rate for Payer: Cash Price |
$1,469.80
|
| Rate for Payer: Cigna Commercial |
$2,439.87
|
| Rate for Payer: First Health Commercial |
$2,792.62
|
| Rate for Payer: Humana Commercial |
$2,498.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,410.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,169.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,586.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,204.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,557.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,028.32
|
| Rate for Payer: PHCS Commercial |
$2,822.02
|
| Rate for Payer: United Healthcare All Payer |
$2,586.85
|
|
|
NEPHR0MAX KIT
|
Facility
|
OP
|
$2,939.60
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$881.88 |
| Max. Negotiated Rate |
$2,822.02 |
| Rate for Payer: Aetna Commercial |
$2,263.49
|
| Rate for Payer: Anthem Medicaid |
$1,010.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,292.89
|
| Rate for Payer: Cash Price |
$1,469.80
|
| Rate for Payer: Cigna Commercial |
$2,439.87
|
| Rate for Payer: First Health Commercial |
$2,792.62
|
| Rate for Payer: Humana Commercial |
$2,498.66
|
| Rate for Payer: Humana KY Medicaid |
$1,010.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,410.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,169.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,586.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,204.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,351.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,557.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,028.32
|
| Rate for Payer: PHCS Commercial |
$2,822.02
|
| Rate for Payer: United Healthcare All Payer |
$2,586.85
|
|
|
NEPHROCAP (MULITPLE VITAMI 1EA
|
Facility
|
IP
|
$4.34
|
|
|
Service Code
|
NDC 63044062201
|
| Hospital Charge Code |
25001061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
NEPHROCAP (MULITPLE VITAMI 1EA
|
Facility
|
OP
|
$4.34
|
|
|
Service Code
|
NDC 63044062201
|
| Hospital Charge Code |
25001061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.60
|
| Rate for Payer: First Health Commercial |
$4.12
|
| Rate for Payer: Humana Commercial |
$3.69
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.82
|
| Rate for Payer: Ohio Health Group HMO |
$3.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.99
|
| Rate for Payer: PHCS Commercial |
$4.17
|
| Rate for Payer: United Healthcare All Payer |
$3.82
|
|
|
NEPRO 237
|
Facility
|
IP
|
$67.15
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004539
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$64.46 |
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.38
|
| Rate for Payer: Cash Price |
$33.58
|
| Rate for Payer: Cigna Commercial |
$55.73
|
| Rate for Payer: First Health Commercial |
$63.79
|
| Rate for Payer: Humana Commercial |
$57.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.09
|
| Rate for Payer: Ohio Health Group HMO |
$50.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.33
|
| Rate for Payer: PHCS Commercial |
$64.46
|
| Rate for Payer: United Healthcare All Payer |
$59.09
|
|
|
NEPRO 237
|
Facility
|
OP
|
$67.15
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
25004539
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.14 |
| Max. Negotiated Rate |
$64.46 |
| Rate for Payer: Aetna Commercial |
$51.71
|
| Rate for Payer: Anthem Medicaid |
$23.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.38
|
| Rate for Payer: Cash Price |
$33.58
|
| Rate for Payer: Cigna Commercial |
$55.73
|
| Rate for Payer: First Health Commercial |
$63.79
|
| Rate for Payer: Humana Commercial |
$57.08
|
| Rate for Payer: Humana KY Medicaid |
$23.09
|
| Rate for Payer: Kentucky WC Medicaid |
$23.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$55.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$59.09
|
| Rate for Payer: Ohio Health Group HMO |
$50.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.33
|
| Rate for Payer: PHCS Commercial |
$64.46
|
| Rate for Payer: United Healthcare All Payer |
$59.09
|
|
|
NEPRO ENTERAL FEEDING 1000 ML
|
Facility
|
OP
|
$77.40
|
|
|
Service Code
|
NDC 70074062670
|
| Hospital Charge Code |
25003257
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem Medicaid |
$26.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Humana KY Medicaid |
$26.62
|
| Rate for Payer: Kentucky WC Medicaid |
$26.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$27.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
NEPRO ENTERAL FEEDING 1000 ML
|
Facility
|
IP
|
$77.40
|
|
|
Service Code
|
NDC 70074062670
|
| Hospital Charge Code |
25003257
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$74.30 |
| Rate for Payer: Aetna Commercial |
$59.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$60.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$64.24
|
| Rate for Payer: First Health Commercial |
$73.53
|
| Rate for Payer: Humana Commercial |
$65.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$63.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$57.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$68.11
|
| Rate for Payer: Ohio Health Group HMO |
$58.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$61.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$67.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.41
|
| Rate for Payer: PHCS Commercial |
$74.30
|
| Rate for Payer: United Healthcare All Payer |
$68.11
|
|
|
NEPTAZANE 50MG TABLET
|
Facility
|
OP
|
$12.60
|
|
|
Service Code
|
NDC 574079101
|
| Hospital Charge Code |
25001062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: Anthem Medicaid |
$4.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.83
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$10.46
|
| Rate for Payer: First Health Commercial |
$11.97
|
| Rate for Payer: Humana Commercial |
$10.71
|
| Rate for Payer: Humana KY Medicaid |
$4.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.09
|
| Rate for Payer: Ohio Health Group HMO |
$9.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.69
|
| Rate for Payer: PHCS Commercial |
$12.10
|
| Rate for Payer: United Healthcare All Payer |
$11.09
|
|
|
NEPTAZANE 50MG TABLET
|
Facility
|
IP
|
$12.60
|
|
|
Service Code
|
NDC 574079101
|
| Hospital Charge Code |
25001062
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna Commercial |
$9.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9.83
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$10.46
|
| Rate for Payer: First Health Commercial |
$11.97
|
| Rate for Payer: Humana Commercial |
$10.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.09
|
| Rate for Payer: Ohio Health Group HMO |
$9.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.69
|
| Rate for Payer: PHCS Commercial |
$12.10
|
| Rate for Payer: United Healthcare All Payer |
$11.09
|
|
|
NERVE GRAFT ARM/LEG <4 CM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64892
|
| Hospital Charge Code |
76102379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,100.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
NERVE GRAFT ARM/LEG <4 CM
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64892
|
| Hospital Charge Code |
76102379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,699.30 |
| Rate for Payer: Aetna Commercial |
$1,699.30
|
| Rate for Payer: Ambetter Exchange |
$995.90
|
| Rate for Payer: Anthem Medicaid |
$743.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$995.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$995.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,195.08
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,524.88
|
| Rate for Payer: Healthspan PPO |
$1,326.77
|
| Rate for Payer: Humana Medicaid |
$743.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,350.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$995.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$758.46
|
| Rate for Payer: Molina Healthcare Passport |
$743.59
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,294.67
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$751.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$995.90
|
|
|
NERVE GRAFT ARM/LEG <4 CM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64892
|
| Hospital Charge Code |
76102379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
NERVE GRAFT ARM/LEG <4 CM(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64892
|
| Hospital Charge Code |
761P2379
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,699.30 |
| Rate for Payer: Aetna Commercial |
$1,699.30
|
| Rate for Payer: Ambetter Exchange |
$995.90
|
| Rate for Payer: Anthem Medicaid |
$743.59
|
| Rate for Payer: Buckeye Individual/Medicaid |
$995.90
|
| Rate for Payer: Buckeye Medicare Advantage |
$995.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,195.08
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,524.88
|
| Rate for Payer: Healthspan PPO |
$1,326.77
|
| Rate for Payer: Humana Medicaid |
$743.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,350.26
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$995.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.90
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$758.46
|
| Rate for Payer: Molina Healthcare Passport |
$743.59
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,294.67
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$751.03
|
| Rate for Payer: Wellcare Medicare Advantage |
$995.90
|
|
|
NERVE GRAFT HAND/FOOT </4 CM
|
Facility
|
OP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64890
|
| Hospital Charge Code |
76102378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$644.81 |
| Max. Negotiated Rate |
$8,284.12 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem Medicaid |
$644.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,917.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,284.12
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,988.26
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Humana KY Medicaid |
$644.81
|
| Rate for Payer: Humana Medicare Advantage |
$5,917.23
|
| Rate for Payer: Kentucky WC Medicaid |
$651.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,100.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
NERVE GRAFT HAND/FOOT </4 CM
|
Facility
|
IP
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64890
|
| Hospital Charge Code |
76102378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$1,443.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,556.25
|
| Rate for Payer: First Health Commercial |
$1,781.25
|
| Rate for Payer: Humana Commercial |
$1,593.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,650.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,406.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.75
|
| Rate for Payer: PHCS Commercial |
$1,800.00
|
| Rate for Payer: United Healthcare All Payer |
$1,650.00
|
|
|
NERVE GRAFT HAND/FOOT </4 CM
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64890
|
| Hospital Charge Code |
76102378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,737.46 |
| Rate for Payer: Aetna Commercial |
$1,737.46
|
| Rate for Payer: Ambetter Exchange |
$1,023.70
|
| Rate for Payer: Anthem Medicaid |
$801.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,023.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,023.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,228.44
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,592.62
|
| Rate for Payer: Healthspan PPO |
$1,356.56
|
| Rate for Payer: Humana Medicaid |
$801.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,391.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,023.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$817.46
|
| Rate for Payer: Molina Healthcare Passport |
$801.43
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.81
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$809.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,023.70
|
|
|
NERVE GRAFT HAND/FOOT </4 C(P
|
Professional
|
Both
|
$1,875.00
|
|
|
Service Code
|
HCPCS 64890
|
| Hospital Charge Code |
761P2378
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$656.25 |
| Max. Negotiated Rate |
$1,737.46 |
| Rate for Payer: Aetna Commercial |
$1,737.46
|
| Rate for Payer: Ambetter Exchange |
$1,023.70
|
| Rate for Payer: Anthem Medicaid |
$801.43
|
| Rate for Payer: Buckeye Individual/Medicaid |
$1,023.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,023.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,228.44
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cash Price |
$937.50
|
| Rate for Payer: Cigna Commercial |
$1,592.62
|
| Rate for Payer: Healthspan PPO |
$1,356.56
|
| Rate for Payer: Humana Medicaid |
$801.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,391.63
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$1,023.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$817.46
|
| Rate for Payer: Molina Healthcare Passport |
$801.43
|
| Rate for Payer: Multiplan PHCS |
$1,125.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,330.81
|
| Rate for Payer: UHCCP Medicaid |
$656.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$809.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$1,023.70
|
|
|
NESTER COIL 14*6
|
Facility
|
OP
|
$1,701.58
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,633.52 |
| Rate for Payer: Aetna Commercial |
$1,310.22
|
| Rate for Payer: Anthem Medicaid |
$585.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.23
|
| Rate for Payer: Cash Price |
$850.79
|
| Rate for Payer: Cigna Commercial |
$1,412.31
|
| Rate for Payer: First Health Commercial |
$1,616.50
|
| Rate for Payer: Humana Commercial |
$1,446.34
|
| Rate for Payer: Humana KY Medicaid |
$585.17
|
| Rate for Payer: Kentucky WC Medicaid |
$591.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.09
|
| Rate for Payer: PHCS Commercial |
$1,633.52
|
| Rate for Payer: United Healthcare All Payer |
$1,497.39
|
|
|
NESTER COIL 14*6
|
Facility
|
IP
|
$1,701.58
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$510.47 |
| Max. Negotiated Rate |
$1,633.52 |
| Rate for Payer: Aetna Commercial |
$1,310.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.23
|
| Rate for Payer: Cash Price |
$850.79
|
| Rate for Payer: Cigna Commercial |
$1,412.31
|
| Rate for Payer: First Health Commercial |
$1,616.50
|
| Rate for Payer: Humana Commercial |
$1,446.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,480.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.09
|
| Rate for Payer: PHCS Commercial |
$1,633.52
|
| Rate for Payer: United Healthcare All Payer |
$1,497.39
|
|
|
NESTER COIL 4MM
|
Facility
|
IP
|
$1,723.66
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.10 |
| Max. Negotiated Rate |
$1,654.71 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.45
|
| Rate for Payer: Cash Price |
$861.83
|
| Rate for Payer: Cigna Commercial |
$1,430.64
|
| Rate for Payer: First Health Commercial |
$1,637.48
|
| Rate for Payer: Humana Commercial |
$1,465.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,413.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,189.33
|
| Rate for Payer: PHCS Commercial |
$1,654.71
|
| Rate for Payer: United Healthcare All Payer |
$1,516.82
|
|
|
NESTER COIL 4MM
|
Facility
|
OP
|
$1,723.66
|
|
|
Service Code
|
HCPCS C1882
|
| Hospital Charge Code |
27000045
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$517.10 |
| Max. Negotiated Rate |
$1,654.71 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Anthem Medicaid |
$592.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.45
|
| Rate for Payer: Cash Price |
$861.83
|
| Rate for Payer: Cigna Commercial |
$1,430.64
|
| Rate for Payer: First Health Commercial |
$1,637.48
|
| Rate for Payer: Humana Commercial |
$1,465.11
|
| Rate for Payer: Humana KY Medicaid |
$592.77
|
| Rate for Payer: Kentucky WC Medicaid |
$598.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,413.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,189.33
|
| Rate for Payer: PHCS Commercial |
$1,654.71
|
| Rate for Payer: United Healthcare All Payer |
$1,516.82
|
|
