|
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: Ambetter Exchange |
$159.01
|
| Rate for Payer: Anthem Medicaid |
$145.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$159.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$159.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$190.81
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$159.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$159.01
|
| 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 |
$206.71
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$146.77
|
| Rate for Payer: Wellcare Medicare Advantage |
$159.01
|
|
|
NRV CNDJ TEST 7-8 STUDIES(T
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
922T0014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,268.16 |
| Rate for Payer: Aetna Commercial |
$1,017.17
|
| Rate for Payer: Anthem Medicaid |
$454.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,030.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,254.95
|
| Rate for Payer: Humana Commercial |
$1,122.85
|
| Rate for Payer: Humana KY Medicaid |
$454.29
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$458.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,083.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$463.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,162.48
|
| Rate for Payer: Ohio Health Group HMO |
$990.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$911.49
|
| Rate for Payer: PHCS Commercial |
$1,268.16
|
| Rate for Payer: United Healthcare All Payer |
$1,162.48
|
|
|
NRV CNDJ TEST 7-8 STUDIES(T
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS 95910
|
| Hospital Charge Code |
922T0014
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$1,268.16 |
| Rate for Payer: Aetna Commercial |
$1,017.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,030.38
|
| Rate for Payer: Cash Price |
$660.50
|
| Rate for Payer: Cigna Commercial |
$1,096.43
|
| Rate for Payer: First Health Commercial |
$1,254.95
|
| Rate for Payer: Humana Commercial |
$1,122.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,083.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$974.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$396.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,162.48
|
| Rate for Payer: Ohio Health Group HMO |
$990.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$911.49
|
| Rate for Payer: PHCS Commercial |
$1,268.16
|
| Rate for Payer: United Healthcare All Payer |
$1,162.48
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$585.00 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Professional
|
Both
|
$1,950.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$153.25 |
| Max. Negotiated Rate |
$1,170.00 |
| Rate for Payer: Ambetter Exchange |
$191.21
|
| Rate for Payer: Anthem Medicaid |
$175.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$191.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.45
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$191.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$179.42
|
| Rate for Payer: Molina Healthcare Passport |
$175.90
|
| Rate for Payer: Multiplan PHCS |
$1,170.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$248.57
|
| Rate for Payer: UHCCP Medicaid |
$682.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.21
|
|
|
NRV CNDJ TEST 9-10 STUDIES
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
92200015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Anthem Medicaid |
$670.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,521.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cash Price |
$975.00
|
| Rate for Payer: Cigna Commercial |
$1,618.50
|
| Rate for Payer: First Health Commercial |
$1,852.50
|
| Rate for Payer: Humana Commercial |
$1,657.50
|
| Rate for Payer: Humana KY Medicaid |
$670.61
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$677.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,599.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,439.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$684.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,716.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,462.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,696.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.50
|
| Rate for Payer: PHCS Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare All Payer |
$1,716.00
|
|
|
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: Ambetter Exchange |
$191.21
|
| Rate for Payer: Anthem Medicaid |
$175.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$191.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$191.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$229.45
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$191.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$191.21
|
| 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 |
$248.57
|
| Rate for Payer: UHCCP Medicaid |
$65.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$177.66
|
| Rate for Payer: Wellcare Medicare Advantage |
$191.21
|
|
|
NRV CNDJ TEST 9-10 STUDIES(T
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
922T0015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$490.26 |
| Max. Negotiated Rate |
$1,692.48 |
| Rate for Payer: Aetna Commercial |
$1,357.51
|
| Rate for Payer: Anthem Medicaid |
$606.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$490.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$686.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$661.85
|
| Rate for Payer: Cash Price |
$881.50
|
| Rate for Payer: Cash Price |
$881.50
|
| Rate for Payer: Cigna Commercial |
$1,463.29
|
| Rate for Payer: First Health Commercial |
$1,674.85
|
| Rate for Payer: Humana Commercial |
$1,498.55
|
| Rate for Payer: Humana KY Medicaid |
$606.30
|
| Rate for Payer: Humana Medicare Advantage |
$490.26
|
| Rate for Payer: Kentucky WC Medicaid |
$612.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.47
|
| Rate for Payer: PHCS Commercial |
$1,692.48
|
| Rate for Payer: United Healthcare All Payer |
$1,551.44
|
|
|
NRV CNDJ TEST 9-10 STUDIES(T
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
HCPCS 95911
|
| Hospital Charge Code |
922T0015
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$528.90 |
| Max. Negotiated Rate |
$1,692.48 |
| Rate for Payer: Aetna Commercial |
$1,357.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.14
|
| Rate for Payer: Cash Price |
$881.50
|
| Rate for Payer: Cigna Commercial |
$1,463.29
|
| Rate for Payer: First Health Commercial |
$1,674.85
|
| Rate for Payer: Humana Commercial |
$1,498.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,533.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.47
|
| Rate for Payer: PHCS Commercial |
$1,692.48
|
| Rate for Payer: United Healthcare All Payer |
$1,551.44
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
92200012
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$683.52 |
| Rate for Payer: Aetna Commercial |
$548.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| 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: 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 |
$213.60
|
| 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 |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
|
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 |
$244.86 |
| 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 |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$555.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| 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 |
$287.73
|
| 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 |
$345.28
|
| 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 |
$569.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.28
|
| Rate for Payer: PHCS Commercial |
$683.52
|
| Rate for Payer: United Healthcare All Payer |
$626.56
|
|
|
NRV CNDJ TST 3-4 STUDIES
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
92200012
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$76.89 |
| Max. Negotiated Rate |
$427.20 |
| Rate for Payer: Ambetter Exchange |
$101.04
|
| Rate for Payer: Anthem Medicaid |
$92.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.25
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cigna Commercial |
$199.84
|
| Rate for Payer: Healthspan PPO |
$115.99
|
| Rate for Payer: Humana Medicaid |
$92.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.94
|
| Rate for Payer: Molina Healthcare Passport |
$92.10
|
| Rate for Payer: Multiplan PHCS |
$427.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.35
|
| Rate for Payer: UHCCP Medicaid |
$249.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.04
|
|
|
NRV CNDJ TST 3-4 STUDIES(P
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
922P0012
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Ambetter Exchange |
$101.04
|
| Rate for Payer: Anthem Medicaid |
$92.10
|
| Rate for Payer: Buckeye Individual/Medicaid |
$101.04
|
| Rate for Payer: Buckeye Medicare Advantage |
$101.04
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.25
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cash Price |
$47.00
|
| Rate for Payer: Cigna Commercial |
$199.84
|
| Rate for Payer: Healthspan PPO |
$115.99
|
| Rate for Payer: Humana Medicaid |
$92.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$101.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.04
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.94
|
| Rate for Payer: Molina Healthcare Passport |
$92.10
|
| Rate for Payer: Multiplan PHCS |
$56.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.35
|
| Rate for Payer: UHCCP Medicaid |
$32.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$93.02
|
| Rate for Payer: Wellcare Medicare Advantage |
$101.04
|
|
|
NRV CNDJ TST 3-4 STUDIES(T
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
922T0012
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$212.53 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem Medicaid |
$212.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Humana KY Medicaid |
$212.53
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$214.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$216.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
NRV CNDJ TST 3-4 STUDIES(T
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
HCPCS 95908
|
| Hospital Charge Code |
922T0012
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$185.40 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$475.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$482.04
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$512.94
|
| Rate for Payer: First Health Commercial |
$587.10
|
| Rate for Payer: Humana Commercial |
$525.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$506.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$456.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$185.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$543.84
|
| Rate for Payer: Ohio Health Group HMO |
$463.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$494.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$537.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$426.42
|
| Rate for Payer: PHCS Commercial |
$593.28
|
| Rate for Payer: United Healthcare All Payer |
$543.84
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
IP
|
$1,077.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
92200013
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$323.10 |
| Max. Negotiated Rate |
$1,033.92 |
| Rate for Payer: Aetna Commercial |
$829.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.06
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cigna Commercial |
$893.91
|
| Rate for Payer: First Health Commercial |
$1,023.15
|
| Rate for Payer: Humana Commercial |
$915.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.76
|
| Rate for Payer: Ohio Health Group HMO |
$807.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$743.13
|
| Rate for Payer: PHCS Commercial |
$1,033.92
|
| Rate for Payer: United Healthcare All Payer |
$947.76
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Facility
|
OP
|
$1,077.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
92200013
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,033.92 |
| Rate for Payer: Aetna Commercial |
$829.29
|
| Rate for Payer: Anthem Medicaid |
$370.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cigna Commercial |
$893.91
|
| Rate for Payer: First Health Commercial |
$1,023.15
|
| Rate for Payer: Humana Commercial |
$915.45
|
| Rate for Payer: Humana KY Medicaid |
$370.38
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$374.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$794.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$377.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$947.76
|
| Rate for Payer: Ohio Health Group HMO |
$807.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$936.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$743.13
|
| Rate for Payer: PHCS Commercial |
$1,033.92
|
| Rate for Payer: United Healthcare All Payer |
$947.76
|
|
|
NRV CNDJ TST 5-6 STUDIES
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
92200013
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$91.69 |
| Max. Negotiated Rate |
$646.20 |
| Rate for Payer: Ambetter Exchange |
$121.54
|
| Rate for Payer: Anthem Medicaid |
$110.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.85
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cash Price |
$538.50
|
| Rate for Payer: Cigna Commercial |
$239.47
|
| Rate for Payer: Healthspan PPO |
$139.05
|
| Rate for Payer: Humana Medicaid |
$110.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.56
|
| Rate for Payer: Molina Healthcare Passport |
$110.35
|
| Rate for Payer: Multiplan PHCS |
$646.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.00
|
| Rate for Payer: UHCCP Medicaid |
$376.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.54
|
|
|
NRV CNDJ TST 5-6 STUDIES(P
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
922P0013
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$239.47 |
| Rate for Payer: Ambetter Exchange |
$121.54
|
| Rate for Payer: Anthem Medicaid |
$110.35
|
| Rate for Payer: Buckeye Individual/Medicaid |
$121.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$121.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$145.85
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cigna Commercial |
$239.47
|
| Rate for Payer: Healthspan PPO |
$139.05
|
| Rate for Payer: Humana Medicaid |
$110.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$91.69
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$121.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$121.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$112.56
|
| Rate for Payer: Molina Healthcare Passport |
$110.35
|
| Rate for Payer: Multiplan PHCS |
$67.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$158.00
|
| Rate for Payer: UHCCP Medicaid |
$39.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$111.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$121.54
|
|
|
NRV CNDJ TST 5-6 STUDIES(T
|
Facility
|
OP
|
$965.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
922T0013
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$926.40 |
| Rate for Payer: Aetna Commercial |
$743.05
|
| Rate for Payer: Anthem Medicaid |
$331.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$752.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$800.95
|
| Rate for Payer: First Health Commercial |
$916.75
|
| Rate for Payer: Humana Commercial |
$820.25
|
| Rate for Payer: Humana KY Medicaid |
$331.86
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$335.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$791.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$338.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.20
|
| Rate for Payer: Ohio Health Group HMO |
$723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$665.85
|
| Rate for Payer: PHCS Commercial |
$926.40
|
| Rate for Payer: United Healthcare All Payer |
$849.20
|
|
|
NRV CNDJ TST 5-6 STUDIES(T
|
Facility
|
IP
|
$965.00
|
|
|
Service Code
|
HCPCS 95909
|
| Hospital Charge Code |
922T0013
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$289.50 |
| Max. Negotiated Rate |
$926.40 |
| Rate for Payer: Aetna Commercial |
$743.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$752.70
|
| Rate for Payer: Cash Price |
$482.50
|
| Rate for Payer: Cigna Commercial |
$800.95
|
| Rate for Payer: First Health Commercial |
$916.75
|
| Rate for Payer: Humana Commercial |
$820.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$791.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$712.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$849.20
|
| Rate for Payer: Ohio Health Group HMO |
$723.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$665.85
|
| Rate for Payer: PHCS Commercial |
$926.40
|
| Rate for Payer: United Healthcare All Payer |
$849.20
|
|
|
NSF CHARGE
|
Professional
|
Both
|
$30.00
|
|
| Hospital Charge Code |
99999999
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Multiplan PHCS |
$18.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$21.00
|
| Rate for Payer: UHCCP Medicaid |
$10.50
|
|
|
NSF CHARGE
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
99999999
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem Medicaid |
$10.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Humana KY Medicaid |
$10.32
|
| Rate for Payer: Kentucky WC Medicaid |
$10.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.70
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
NSF CHARGE
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
99999999
|
|
Hospital Revenue Code
|
222
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna Commercial |
$23.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$23.40
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$24.90
|
| Rate for Payer: First Health Commercial |
$28.50
|
| Rate for Payer: Humana Commercial |
$25.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$26.40
|
| Rate for Payer: Ohio Health Group HMO |
$22.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20.70
|
| Rate for Payer: PHCS Commercial |
$28.80
|
| Rate for Payer: United Healthcare All Payer |
$26.40
|
|
|
NSL/SINS NDSC TOTAL
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 31253
|
| Hospital Charge Code |
76101152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$854.49 |
| Rate for Payer: Ambetter Exchange |
$470.70
|
| Rate for Payer: Anthem Medicaid |
$398.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$470.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$470.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$564.84
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$854.49
|
| Rate for Payer: Humana Medicaid |
$398.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$659.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$470.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$470.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$406.16
|
| Rate for Payer: Molina Healthcare Passport |
$398.20
|
| Rate for Payer: Multiplan PHCS |
$423.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$611.91
|
| Rate for Payer: UHCCP Medicaid |
$246.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$402.18
|
| Rate for Payer: Wellcare Medicare Advantage |
$470.70
|
|
