|
NEUPRO 8MG PATCH (24HR)
|
Facility
|
IP
|
$66.80
|
|
|
Service Code
|
NDC 50474080603
|
| Hospital Charge Code |
25003267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$64.13 |
| Rate for Payer: Aetna Commercial |
$51.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.10
|
| Rate for Payer: Cash Price |
$33.40
|
| Rate for Payer: Cigna Commercial |
$55.44
|
| Rate for Payer: First Health Commercial |
$63.46
|
| Rate for Payer: Humana Commercial |
$56.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.78
|
| Rate for Payer: Ohio Health Group HMO |
$50.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.09
|
| Rate for Payer: PHCS Commercial |
$64.13
|
| Rate for Payer: United Healthcare All Payer |
$58.78
|
|
|
NEUPRO 8MG PATCH (24HR)
|
Facility
|
OP
|
$66.80
|
|
|
Service Code
|
NDC 50474080603
|
| Hospital Charge Code |
25003267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$64.13 |
| Rate for Payer: Aetna Commercial |
$51.44
|
| Rate for Payer: Anthem Medicaid |
$22.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$52.10
|
| Rate for Payer: Cash Price |
$33.40
|
| Rate for Payer: Cigna Commercial |
$55.44
|
| Rate for Payer: First Health Commercial |
$63.46
|
| Rate for Payer: Humana Commercial |
$56.78
|
| Rate for Payer: Humana KY Medicaid |
$22.97
|
| Rate for Payer: Kentucky WC Medicaid |
$23.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$54.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$49.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$23.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$58.78
|
| Rate for Payer: Ohio Health Group HMO |
$50.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$53.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$58.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$46.09
|
| Rate for Payer: PHCS Commercial |
$64.13
|
| Rate for Payer: United Healthcare All Payer |
$58.78
|
|
|
NEURECTOMY FOOT
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 28055
|
| Hospital Charge Code |
76102745
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$645.47 |
| Rate for Payer: Aetna Commercial |
$599.54
|
| Rate for Payer: Ambetter Exchange |
$370.41
|
| Rate for Payer: Anthem Medicaid |
$289.13
|
| Rate for Payer: Buckeye Individual/Medicaid |
$370.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$370.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$444.49
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.47
|
| Rate for Payer: Healthspan PPO |
$543.05
|
| Rate for Payer: Humana Medicaid |
$289.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$471.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$370.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$370.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$294.91
|
| Rate for Payer: Molina Healthcare Passport |
$289.13
|
| Rate for Payer: Multiplan PHCS |
$243.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$481.53
|
| Rate for Payer: UHCCP Medicaid |
$141.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$292.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$370.41
|
|
|
NEUROBEHAVIORAL STATUS
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
HCPCS 96116
|
| Hospital Charge Code |
51000047
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.30 |
| Max. Negotiated Rate |
$542.40 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Anthem Medicaid |
$194.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cigna Commercial |
$468.95
|
| Rate for Payer: First Health Commercial |
$536.75
|
| Rate for Payer: Humana Commercial |
$480.25
|
| Rate for Payer: Humana KY Medicaid |
$194.30
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$196.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.20
|
| Rate for Payer: Ohio Health Group HMO |
$423.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$491.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.85
|
| Rate for Payer: PHCS Commercial |
$542.40
|
| Rate for Payer: United Healthcare All Payer |
$497.20
|
|
|
NEUROBEHAVIORAL STATUS
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
HCPCS 96116
|
| Hospital Charge Code |
51000047
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$542.40 |
| Rate for Payer: Aetna Commercial |
$435.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$440.70
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cigna Commercial |
$468.95
|
| Rate for Payer: First Health Commercial |
$536.75
|
| Rate for Payer: Humana Commercial |
$480.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$463.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$416.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$497.20
|
| Rate for Payer: Ohio Health Group HMO |
$423.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$491.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$389.85
|
| Rate for Payer: PHCS Commercial |
$542.40
|
| Rate for Payer: United Healthcare All Payer |
$497.20
|
|
|
NEUROBEHAVIORAL STATUS
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
HCPCS 96116
|
| Hospital Charge Code |
51000047
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Ambetter Exchange |
$75.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.66
|
| Rate for Payer: Anthem Medicaid |
$68.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.20
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cash Price |
$282.50
|
| Rate for Payer: Cigna Commercial |
$131.05
|
| Rate for Payer: Healthspan PPO |
$143.22
|
| Rate for Payer: Humana Medicaid |
$68.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.58
|
| Rate for Payer: Molina Healthcare Passport |
$68.22
|
| Rate for Payer: Multiplan PHCS |
$339.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.72
|
| Rate for Payer: UHCCP Medicaid |
$57.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.17
|
|
|
NEUROBEHAVIORAL STATUS(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 96116
|
| Hospital Charge Code |
510P0047
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Ambetter Exchange |
$75.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$54.66
|
| Rate for Payer: Anthem Medicaid |
$68.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$75.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$75.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$90.20
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$131.05
|
| Rate for Payer: Healthspan PPO |
$143.22
|
| Rate for Payer: Humana Medicaid |
$68.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$99.61
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$75.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$75.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$69.58
|
| Rate for Payer: Molina Healthcare Passport |
$68.22
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$97.72
|
| Rate for Payer: UHCCP Medicaid |
$57.39
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$68.90
|
| Rate for Payer: Wellcare Medicare Advantage |
$75.17
|
|
|
NEUROBEHAVIORAL STATUS(T
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS 96116
|
| Hospital Charge Code |
510T0047
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.50 |
| Max. Negotiated Rate |
$398.40 |
| Rate for Payer: Aetna Commercial |
$319.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.70
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: First Health Commercial |
$394.25
|
| Rate for Payer: Humana Commercial |
$352.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$340.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$306.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$124.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$365.20
|
| Rate for Payer: Ohio Health Group HMO |
$311.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.35
|
| Rate for Payer: PHCS Commercial |
$398.40
|
| Rate for Payer: United Healthcare All Payer |
$365.20
|
|
|
NEUROBEHAVIORAL STATUS(T
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS 96116
|
| Hospital Charge Code |
510T0047
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.72 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$319.55
|
| Rate for Payer: Anthem Medicaid |
$142.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$323.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cash Price |
$207.50
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: First Health Commercial |
$394.25
|
| Rate for Payer: Humana Commercial |
$352.75
|
| Rate for Payer: Humana KY Medicaid |
$142.72
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$144.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$340.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$306.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$145.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$365.20
|
| Rate for Payer: Ohio Health Group HMO |
$311.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$361.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$286.35
|
| Rate for Payer: PHCS Commercial |
$398.40
|
| Rate for Payer: United Healthcare All Payer |
$365.20
|
|
|
NEUROELTRD STIM POST TIBIAL
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS 64566
|
| Hospital Charge Code |
76102789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.30 |
| Max. Negotiated Rate |
$519.36 |
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$449.03
|
| Rate for Payer: First Health Commercial |
$513.95
|
| Rate for Payer: Humana Commercial |
$459.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.08
|
| Rate for Payer: Ohio Health Group HMO |
$405.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.29
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
NEUROELTRD STIM POST TIBIAL
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS 64566
|
| Hospital Charge Code |
76102789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$186.05 |
| Max. Negotiated Rate |
$519.36 |
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Anthem Medicaid |
$186.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$449.03
|
| Rate for Payer: First Health Commercial |
$513.95
|
| Rate for Payer: Humana Commercial |
$459.85
|
| Rate for Payer: Humana KY Medicaid |
$186.05
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$187.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.08
|
| Rate for Payer: Ohio Health Group HMO |
$405.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.29
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
NEUROELTRD STIM POST TIBIAL
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 64566
|
| Hospital Charge Code |
76102789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$324.60 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Ambetter Exchange |
$28.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.58
|
| Rate for Payer: Anthem Medicaid |
$98.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.88
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$221.18
|
| Rate for Payer: Healthspan PPO |
$127.67
|
| Rate for Payer: Humana Medicaid |
$98.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.08
|
| Rate for Payer: Molina Healthcare Passport |
$98.12
|
| Rate for Payer: Multiplan PHCS |
$324.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.23
|
|
|
NEUROELTRD STIM POST TIBIAL (P
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 64566
|
| Hospital Charge Code |
761P2789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna Commercial |
$51.85
|
| Rate for Payer: Ambetter Exchange |
$28.23
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$15.58
|
| Rate for Payer: Anthem Medicaid |
$98.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$28.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$28.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$33.88
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$221.18
|
| Rate for Payer: Healthspan PPO |
$127.67
|
| Rate for Payer: Humana Medicaid |
$98.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.27
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$28.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.08
|
| Rate for Payer: Molina Healthcare Passport |
$98.12
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$36.70
|
| Rate for Payer: UHCCP Medicaid |
$16.36
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$28.23
|
|
|
NEUROELTRD STIM POST TIBIAL (T
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
HCPCS 64566
|
| Hospital Charge Code |
761T2789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.30 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$120.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.69
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
NEUROELTRD STIM POST TIBIAL (T
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
HCPCS 64566
|
| Hospital Charge Code |
761T2789
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$384.96 |
| Rate for Payer: Aetna Commercial |
$308.77
|
| Rate for Payer: Anthem Medicaid |
$137.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$272.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$312.78
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$381.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$368.21
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cash Price |
$200.50
|
| Rate for Payer: Cigna Commercial |
$332.83
|
| Rate for Payer: First Health Commercial |
$380.95
|
| Rate for Payer: Humana Commercial |
$340.85
|
| Rate for Payer: Humana KY Medicaid |
$137.90
|
| Rate for Payer: Humana Medicare Advantage |
$272.75
|
| Rate for Payer: Kentucky WC Medicaid |
$139.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$328.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$295.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$140.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$352.88
|
| Rate for Payer: Ohio Health Group HMO |
$300.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$320.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$348.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$276.69
|
| Rate for Payer: PHCS Commercial |
$384.96
|
| Rate for Payer: United Healthcare All Payer |
$352.88
|
|
|
NEUROMEND 12MM*2.5CM
|
Facility
|
OP
|
$8,080.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,424.24 |
| Max. Negotiated Rate |
$7,757.57 |
| Rate for Payer: Aetna Commercial |
$6,222.22
|
| Rate for Payer: Anthem Medicaid |
$2,778.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,303.02
|
| Rate for Payer: Cash Price |
$4,040.40
|
| Rate for Payer: Cigna Commercial |
$6,707.06
|
| Rate for Payer: First Health Commercial |
$7,676.76
|
| Rate for Payer: Humana Commercial |
$6,868.68
|
| Rate for Payer: Humana KY Medicaid |
$2,778.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,807.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,626.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,834.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,111.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,464.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,030.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,575.75
|
| Rate for Payer: PHCS Commercial |
$7,757.57
|
| Rate for Payer: United Healthcare All Payer |
$7,111.10
|
|
|
NEUROMEND 12MM*2.5CM
|
Facility
|
IP
|
$8,080.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,424.24 |
| Max. Negotiated Rate |
$7,757.57 |
| Rate for Payer: Aetna Commercial |
$6,222.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,303.02
|
| Rate for Payer: Cash Price |
$4,040.40
|
| Rate for Payer: Cigna Commercial |
$6,707.06
|
| Rate for Payer: First Health Commercial |
$7,676.76
|
| Rate for Payer: Humana Commercial |
$6,868.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,626.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,111.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,464.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,030.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,575.75
|
| Rate for Payer: PHCS Commercial |
$7,757.57
|
| Rate for Payer: United Healthcare All Payer |
$7,111.10
|
|
|
NEUROMEND 12MM*5.0CM
|
Facility
|
IP
|
$8,518.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.64 |
| Max. Negotiated Rate |
$8,178.05 |
| Rate for Payer: Aetna Commercial |
$6,559.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,644.66
|
| Rate for Payer: Cash Price |
$4,259.40
|
| Rate for Payer: Cigna Commercial |
$7,070.60
|
| Rate for Payer: First Health Commercial |
$8,092.86
|
| Rate for Payer: Humana Commercial |
$7,240.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,985.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,286.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,496.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,389.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,815.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,411.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,877.97
|
| Rate for Payer: PHCS Commercial |
$8,178.05
|
| Rate for Payer: United Healthcare All Payer |
$7,496.54
|
|
|
NEUROMEND 12MM*5.0CM
|
Facility
|
OP
|
$8,518.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.64 |
| Max. Negotiated Rate |
$8,178.05 |
| Rate for Payer: Aetna Commercial |
$6,559.48
|
| Rate for Payer: Anthem Medicaid |
$2,929.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,644.66
|
| Rate for Payer: Cash Price |
$4,259.40
|
| Rate for Payer: Cigna Commercial |
$7,070.60
|
| Rate for Payer: First Health Commercial |
$8,092.86
|
| Rate for Payer: Humana Commercial |
$7,240.98
|
| Rate for Payer: Humana KY Medicaid |
$2,929.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,959.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,985.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,286.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,988.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,496.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,389.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,815.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,411.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,877.97
|
| Rate for Payer: PHCS Commercial |
$8,178.05
|
| Rate for Payer: United Healthcare All Payer |
$7,496.54
|
|
|
NEUROMEND 4MM*2.5CM
|
Facility
|
OP
|
$8,080.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,424.24 |
| Max. Negotiated Rate |
$7,757.57 |
| Rate for Payer: Aetna Commercial |
$6,222.22
|
| Rate for Payer: Anthem Medicaid |
$2,778.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,303.02
|
| Rate for Payer: Cash Price |
$4,040.40
|
| Rate for Payer: Cigna Commercial |
$6,707.06
|
| Rate for Payer: First Health Commercial |
$7,676.76
|
| Rate for Payer: Humana Commercial |
$6,868.68
|
| Rate for Payer: Humana KY Medicaid |
$2,778.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,807.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,626.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,834.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,111.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,464.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,030.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,575.75
|
| Rate for Payer: PHCS Commercial |
$7,757.57
|
| Rate for Payer: United Healthcare All Payer |
$7,111.10
|
|
|
NEUROMEND 4MM*2.5CM
|
Facility
|
IP
|
$8,080.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,424.24 |
| Max. Negotiated Rate |
$7,757.57 |
| Rate for Payer: Aetna Commercial |
$6,222.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,303.02
|
| Rate for Payer: Cash Price |
$4,040.40
|
| Rate for Payer: Cigna Commercial |
$6,707.06
|
| Rate for Payer: First Health Commercial |
$7,676.76
|
| Rate for Payer: Humana Commercial |
$6,868.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,626.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,111.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,464.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,030.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,575.75
|
| Rate for Payer: PHCS Commercial |
$7,757.57
|
| Rate for Payer: United Healthcare All Payer |
$7,111.10
|
|
|
NEUROMEND 4MM*5.0CM
|
Facility
|
OP
|
$8,518.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.64 |
| Max. Negotiated Rate |
$8,178.05 |
| Rate for Payer: Aetna Commercial |
$6,559.48
|
| Rate for Payer: Anthem Medicaid |
$2,929.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,644.66
|
| Rate for Payer: Cash Price |
$4,259.40
|
| Rate for Payer: Cigna Commercial |
$7,070.60
|
| Rate for Payer: First Health Commercial |
$8,092.86
|
| Rate for Payer: Humana Commercial |
$7,240.98
|
| Rate for Payer: Humana KY Medicaid |
$2,929.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,959.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,985.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,286.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,988.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,496.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,389.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,815.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,411.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,877.97
|
| Rate for Payer: PHCS Commercial |
$8,178.05
|
| Rate for Payer: United Healthcare All Payer |
$7,496.54
|
|
|
NEUROMEND 4MM*5.0CM
|
Facility
|
IP
|
$8,518.80
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,555.64 |
| Max. Negotiated Rate |
$8,178.05 |
| Rate for Payer: Aetna Commercial |
$6,559.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,644.66
|
| Rate for Payer: Cash Price |
$4,259.40
|
| Rate for Payer: Cigna Commercial |
$7,070.60
|
| Rate for Payer: First Health Commercial |
$8,092.86
|
| Rate for Payer: Humana Commercial |
$7,240.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,985.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,286.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,555.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,496.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,389.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,815.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,411.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,877.97
|
| Rate for Payer: PHCS Commercial |
$8,178.05
|
| Rate for Payer: United Healthcare All Payer |
$7,496.54
|
|
|
NEUROMEND 6MM*2.5CM
|
Facility
|
OP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem Medicaid |
$2,851.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Humana KY Medicaid |
$2,851.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,880.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,909.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
|
NEUROMEND 6MM*2.5CM
|
Facility
|
IP
|
$8,292.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,487.75 |
| Max. Negotiated Rate |
$7,960.80 |
| Rate for Payer: Aetna Commercial |
$6,385.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,468.15
|
| Rate for Payer: Cash Price |
$4,146.25
|
| Rate for Payer: Cigna Commercial |
$6,882.77
|
| Rate for Payer: First Health Commercial |
$7,877.88
|
| Rate for Payer: Humana Commercial |
$7,048.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,799.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,119.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,297.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,219.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,634.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,214.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,721.82
|
| Rate for Payer: PHCS Commercial |
$7,960.80
|
| Rate for Payer: United Healthcare All Payer |
$7,297.40
|
|
