|
NSL/SINS NDSC TOTAL
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
HCPCS 31253
|
| Hospital Charge Code |
76101152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$676.80 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
NSL/SINS NDSC TOTAL
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
HCPCS 31253
|
| Hospital Charge Code |
76101152
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.45 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$542.85
|
| Rate for Payer: Anthem Medicaid |
$242.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$549.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cash Price |
$352.50
|
| Rate for Payer: Cigna Commercial |
$585.15
|
| Rate for Payer: First Health Commercial |
$669.75
|
| Rate for Payer: Humana Commercial |
$599.25
|
| Rate for Payer: Humana KY Medicaid |
$242.45
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$244.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$578.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$520.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$620.40
|
| Rate for Payer: Ohio Health Group HMO |
$528.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$564.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$486.45
|
| Rate for Payer: PHCS Commercial |
$676.80
|
| Rate for Payer: United Healthcare All Payer |
$620.40
|
|
|
NSL/SINS NDSC TOTAL(P
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 31253
|
| Hospital Charge Code |
761P1152
|
|
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
|
|
|
NSL/SINS NDSC W/ARTERY LIG
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 31241
|
| Hospital Charge Code |
76101151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$762.37 |
| Rate for Payer: Ambetter Exchange |
$418.35
|
| Rate for Payer: Anthem Medicaid |
$355.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$418.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$418.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$502.02
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$762.37
|
| Rate for Payer: Humana Medicaid |
$355.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$588.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$418.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.19
|
| Rate for Payer: Molina Healthcare Passport |
$355.09
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.86
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$418.35
|
|
|
NSL/SINS NDSC W/ARTERY LIG
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
HCPCS 31241
|
| Hospital Charge Code |
76101151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$195.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
NSL/SINS NDSC W/ARTERY LIG
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
HCPCS 31241
|
| Hospital Charge Code |
76101151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.53 |
| Max. Negotiated Rate |
$2,230.73 |
| Rate for Payer: Aetna Commercial |
$500.50
|
| Rate for Payer: Anthem Medicaid |
$223.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,593.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$507.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,230.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,151.06
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$539.50
|
| Rate for Payer: First Health Commercial |
$617.50
|
| Rate for Payer: Humana Commercial |
$552.50
|
| Rate for Payer: Humana KY Medicaid |
$223.53
|
| Rate for Payer: Humana Medicare Advantage |
$1,593.38
|
| Rate for Payer: Kentucky WC Medicaid |
$225.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$533.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$479.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,912.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$228.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$572.00
|
| Rate for Payer: Ohio Health Group HMO |
$487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$448.50
|
| Rate for Payer: PHCS Commercial |
$624.00
|
| Rate for Payer: United Healthcare All Payer |
$572.00
|
|
|
NSL/SINS NDSC W/ARTERY LIG(P
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 31241
|
| Hospital Charge Code |
761P1151
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$227.50 |
| Max. Negotiated Rate |
$762.37 |
| Rate for Payer: Ambetter Exchange |
$418.35
|
| Rate for Payer: Anthem Medicaid |
$355.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$418.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$418.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$502.02
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cash Price |
$325.00
|
| Rate for Payer: Cigna Commercial |
$762.37
|
| Rate for Payer: Humana Medicaid |
$355.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$588.80
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$418.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$418.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.19
|
| Rate for Payer: Molina Healthcare Passport |
$355.09
|
| Rate for Payer: Multiplan PHCS |
$390.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$543.86
|
| Rate for Payer: UHCCP Medicaid |
$227.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$358.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$418.35
|
|
|
NSL/SINS NDSC W/TOT ETHMDCT
|
Facility
|
IP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31255
|
| Hospital Charge Code |
76101154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$570.00 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
NSL/SINS NDSC W/TOT ETHMDCT
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31255
|
| Hospital Charge Code |
76101154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.45 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$623.39
|
| Rate for Payer: Ambetter Exchange |
$304.45
|
| Rate for Payer: Anthem Medicaid |
$470.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$365.34
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$629.88
|
| Rate for Payer: Healthspan PPO |
$525.72
|
| Rate for Payer: Humana Medicaid |
$470.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$480.33
|
| Rate for Payer: Molina Healthcare Passport |
$470.91
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.79
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$475.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.45
|
|
|
NSL/SINS NDSC W/TOT ETHMDCT
|
Facility
|
OP
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31255
|
| Hospital Charge Code |
76101154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$653.41 |
| Max. Negotiated Rate |
$8,954.71 |
| Rate for Payer: Aetna Commercial |
$1,463.00
|
| Rate for Payer: Anthem Medicaid |
$653.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,396.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,954.71
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,634.90
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$1,577.00
|
| Rate for Payer: First Health Commercial |
$1,805.00
|
| Rate for Payer: Humana Commercial |
$1,615.00
|
| Rate for Payer: Humana KY Medicaid |
$653.41
|
| Rate for Payer: Humana Medicare Advantage |
$6,396.22
|
| Rate for Payer: Kentucky WC Medicaid |
$660.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,675.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.00
|
| Rate for Payer: PHCS Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare All Payer |
$1,672.00
|
|
|
NSL/SINS NDSC W/TOT ETHMDCT(P
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 31255
|
| Hospital Charge Code |
761P1154
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$304.45 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$623.39
|
| Rate for Payer: Ambetter Exchange |
$304.45
|
| Rate for Payer: Anthem Medicaid |
$470.91
|
| Rate for Payer: Buckeye Individual/Medicaid |
$304.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$304.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$365.34
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cash Price |
$950.00
|
| Rate for Payer: Cigna Commercial |
$629.88
|
| Rate for Payer: Healthspan PPO |
$525.72
|
| Rate for Payer: Humana Medicaid |
$470.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$524.58
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$304.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$304.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$480.33
|
| Rate for Payer: Molina Healthcare Passport |
$470.91
|
| Rate for Payer: Multiplan PHCS |
$1,140.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$395.79
|
| Rate for Payer: UHCCP Medicaid |
$665.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$475.62
|
| Rate for Payer: Wellcare Medicare Advantage |
$304.45
|
|
|
NSPACE BALLOON IMPLANT - SMALL
|
Facility
|
IP
|
$29,375.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,812.50 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$22,618.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,912.50
|
| Rate for Payer: Cash Price |
$14,687.50
|
| Rate for Payer: Cigna Commercial |
$24,381.25
|
| Rate for Payer: First Health Commercial |
$27,906.25
|
| Rate for Payer: Humana Commercial |
$24,968.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,087.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,678.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,812.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,850.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,556.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,268.75
|
| Rate for Payer: PHCS Commercial |
$28,200.00
|
| Rate for Payer: United Healthcare All Payer |
$25,850.00
|
|
|
NSPACE BALLOON IMPLANT - SMALL
|
Facility
|
OP
|
$29,375.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8,812.50 |
| Max. Negotiated Rate |
$28,200.00 |
| Rate for Payer: Aetna Commercial |
$22,618.75
|
| Rate for Payer: Anthem Medicaid |
$10,102.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,912.50
|
| Rate for Payer: Cash Price |
$14,687.50
|
| Rate for Payer: Cigna Commercial |
$24,381.25
|
| Rate for Payer: First Health Commercial |
$27,906.25
|
| Rate for Payer: Humana Commercial |
$24,968.75
|
| Rate for Payer: Humana KY Medicaid |
$10,102.06
|
| Rate for Payer: Kentucky WC Medicaid |
$10,204.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$24,087.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,678.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,812.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,304.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,850.00
|
| Rate for Payer: Ohio Health Group HMO |
$22,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$23,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$25,556.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$20,268.75
|
| Rate for Payer: PHCS Commercial |
$28,200.00
|
| Rate for Payer: United Healthcare All Payer |
$25,850.00
|
|
|
NT PRO BNP P
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem Medicaid |
$39.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$39.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54.96
|
| Rate for Payer: CareSource Just4Me Medicare |
$39.26
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Humana KY Medicaid |
$39.26
|
| Rate for Payer: Humana Medicare Advantage |
$39.26
|
| Rate for Payer: Kentucky WC Medicaid |
$39.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
NT PRO BNP P
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
HCPCS 83880
|
| Hospital Charge Code |
30000455
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$146.88 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.86
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$126.99
|
| Rate for Payer: First Health Commercial |
$145.35
|
| Rate for Payer: Humana Commercial |
$130.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$125.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$134.64
|
| Rate for Payer: Ohio Health Group HMO |
$114.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$122.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$105.57
|
| Rate for Payer: PHCS Commercial |
$146.88
|
| Rate for Payer: United Healthcare All Payer |
$134.64
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
76102635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem Medicaid |
$24.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Humana KY Medicaid |
$24.07
|
| Rate for Payer: Kentucky WC Medicaid |
$24.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$24.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
76102635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$53.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$54.60
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cigna Commercial |
$58.10
|
| Rate for Payer: First Health Commercial |
$66.50
|
| Rate for Payer: Humana Commercial |
$59.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$57.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$51.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$61.60
|
| Rate for Payer: Ohio Health Group HMO |
$52.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$60.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$48.30
|
| Rate for Payer: PHCS Commercial |
$67.20
|
| Rate for Payer: United Healthcare All Payer |
$61.60
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
761P2635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Ambetter Exchange |
$33.78
|
| Rate for Payer: Anthem Medicaid |
$28.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.54
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$28.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.37
|
| Rate for Payer: Molina Healthcare Passport |
$28.79
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.91
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.78
|
|
|
NTRPROF PH1/NTRNET/EHR 11-20
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99447
|
| Hospital Charge Code |
76102635
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$47.65 |
| Rate for Payer: Ambetter Exchange |
$33.78
|
| Rate for Payer: Anthem Medicaid |
$28.79
|
| Rate for Payer: Buckeye Individual/Medicaid |
$33.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$33.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$40.54
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$28.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.65
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$33.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$29.37
|
| Rate for Payer: Molina Healthcare Passport |
$28.79
|
| Rate for Payer: Multiplan PHCS |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$43.91
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$29.08
|
| Rate for Payer: Wellcare Medicare Advantage |
$33.78
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
76102633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem Medicaid |
$30.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Humana KY Medicaid |
$30.95
|
| Rate for Payer: Kentucky WC Medicaid |
$31.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
761P2633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$71.71 |
| Rate for Payer: Ambetter Exchange |
$50.19
|
| Rate for Payer: Anthem Medicaid |
$43.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.23
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$43.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.19
|
| Rate for Payer: Molina Healthcare Passport |
$43.32
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.25
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.19
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
76102633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$70.20
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$74.70
|
| Rate for Payer: First Health Commercial |
$85.50
|
| Rate for Payer: Humana Commercial |
$76.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$73.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$66.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$79.20
|
| Rate for Payer: Ohio Health Group HMO |
$67.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$72.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$78.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$62.10
|
| Rate for Payer: PHCS Commercial |
$86.40
|
| Rate for Payer: United Healthcare All Payer |
$79.20
|
|
|
NTRPROF PH1/NTRNET/EHR 21-30
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 99448
|
| Hospital Charge Code |
76102633
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$71.71 |
| Rate for Payer: Ambetter Exchange |
$50.19
|
| Rate for Payer: Anthem Medicaid |
$43.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$50.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$60.23
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Humana Medicaid |
$43.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.71
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$50.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$44.19
|
| Rate for Payer: Molina Healthcare Passport |
$43.32
|
| Rate for Payer: Multiplan PHCS |
$54.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$65.25
|
| Rate for Payer: UHCCP Medicaid |
$31.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.75
|
| Rate for Payer: Wellcare Medicare Advantage |
$50.19
|
|
|
NUBAIN(NALBUPHINE)10M 10MG/1ML
|
Facility
|
IP
|
$79.86
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
25002256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Aetna Commercial |
$61.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.29
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cigna Commercial |
$66.28
|
| Rate for Payer: First Health Commercial |
$75.87
|
| Rate for Payer: Humana Commercial |
$67.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.10
|
| Rate for Payer: PHCS Commercial |
$76.67
|
| Rate for Payer: United Healthcare All Payer |
$70.28
|
|
|
NUBAIN(NALBUPHINE)10M 10MG/1ML
|
Facility
|
OP
|
$79.86
|
|
|
Service Code
|
HCPCS J2300
|
| Hospital Charge Code |
25002256
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.96 |
| Max. Negotiated Rate |
$76.67 |
| Rate for Payer: Aetna Commercial |
$61.49
|
| Rate for Payer: Anthem Medicaid |
$27.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.29
|
| Rate for Payer: Cash Price |
$39.93
|
| Rate for Payer: Cigna Commercial |
$66.28
|
| Rate for Payer: First Health Commercial |
$75.87
|
| Rate for Payer: Humana Commercial |
$67.88
|
| Rate for Payer: Humana KY Medicaid |
$27.46
|
| Rate for Payer: Kentucky WC Medicaid |
$27.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$58.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$23.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.28
|
| Rate for Payer: Ohio Health Group HMO |
$59.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$63.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.10
|
| Rate for Payer: PHCS Commercial |
$76.67
|
| Rate for Payer: United Healthcare All Payer |
$70.28
|
|
