|
NURSING FACILITY DISCHARGE
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99315
|
| Hospital Charge Code |
51000067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Ambetter Exchange |
$76.32
|
| Rate for Payer: Anthem Medicaid |
$46.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$76.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.58
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$87.33
|
| Rate for Payer: Healthspan PPO |
$68.25
|
| Rate for Payer: Humana Medicaid |
$46.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$76.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.63
|
| Rate for Payer: Molina Healthcare Passport |
$46.70
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$99.22
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$76.32
|
|
|
NURSING FACILITY DISCHARGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
HCPCS 99315
|
| Hospital Charge Code |
51000067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem Medicaid |
$34.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Humana KY Medicaid |
$34.39
|
| Rate for Payer: Kentucky WC Medicaid |
$34.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
NURSING FACILITY DISCHARGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
HCPCS 99315
|
| Hospital Charge Code |
51000067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$77.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$78.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$83.00
|
| Rate for Payer: First Health Commercial |
$95.00
|
| Rate for Payer: Humana Commercial |
$85.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$82.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$73.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$88.00
|
| Rate for Payer: Ohio Health Group HMO |
$75.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$80.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$87.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$69.00
|
| Rate for Payer: PHCS Commercial |
$96.00
|
| Rate for Payer: United Healthcare All Payer |
$88.00
|
|
|
NURSING FACILITY DISCHARGE(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99315
|
| Hospital Charge Code |
510P0067
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$99.22 |
| Rate for Payer: Aetna Commercial |
$91.81
|
| Rate for Payer: Ambetter Exchange |
$76.32
|
| Rate for Payer: Anthem Medicaid |
$46.70
|
| Rate for Payer: Buckeye Individual/Medicaid |
$76.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$76.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$91.58
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$87.33
|
| Rate for Payer: Healthspan PPO |
$68.25
|
| Rate for Payer: Humana Medicaid |
$46.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$76.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$76.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$47.63
|
| Rate for Payer: Molina Healthcare Passport |
$46.70
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$99.22
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$47.17
|
| Rate for Payer: Wellcare Medicare Advantage |
$76.32
|
|
|
NURSING HOME DISCHG PROLONG
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
51000068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$41.27
|
| Rate for Payer: Kentucky WC Medicaid |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
NURSING HOME DISCHG PROLONG
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
51000068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
NURSING HOME DISCHG PROLONG
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
51000068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Ambetter Exchange |
$122.46
|
| Rate for Payer: Anthem Medicaid |
$81.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.95
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: Healthspan PPO |
$89.04
|
| Rate for Payer: Humana Medicaid |
$81.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.89
|
| Rate for Payer: Molina Healthcare Passport |
$81.26
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.20
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.46
|
|
|
NURSING HOME DISCHG PROLONG(P
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 99316
|
| Hospital Charge Code |
510P0068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$159.20 |
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Ambetter Exchange |
$122.46
|
| Rate for Payer: Anthem Medicaid |
$81.26
|
| Rate for Payer: Buckeye Individual/Medicaid |
$122.46
|
| Rate for Payer: Buckeye Medicare Advantage |
$122.46
|
| Rate for Payer: CareSource Just4Me Medicare |
$146.95
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: Healthspan PPO |
$89.04
|
| Rate for Payer: Humana Medicaid |
$81.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$108.83
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$122.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$122.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$82.89
|
| Rate for Payer: Molina Healthcare Passport |
$81.26
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$159.20
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$82.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$122.46
|
|
|
NUSHIELD 2*3
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
27000191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NUSHIELD 2*3
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS Q4160
|
| Hospital Charge Code |
27000191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
NUT CPS CO-CR-MO ALLOY
|
Facility
|
IP
|
$3,957.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.25 |
| Max. Negotiated Rate |
$3,799.20 |
| Rate for Payer: Aetna Commercial |
$3,047.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,086.85
|
| Rate for Payer: Cash Price |
$1,978.75
|
| Rate for Payer: Cigna Commercial |
$3,284.72
|
| Rate for Payer: First Health Commercial |
$3,759.62
|
| Rate for Payer: Humana Commercial |
$3,363.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,443.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,730.68
|
| Rate for Payer: PHCS Commercial |
$3,799.20
|
| Rate for Payer: United Healthcare All Payer |
$3,482.60
|
|
|
NUT CPS CO-CR-MO ALLOY
|
Facility
|
OP
|
$3,957.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.25 |
| Max. Negotiated Rate |
$3,799.20 |
| Rate for Payer: Aetna Commercial |
$3,047.28
|
| Rate for Payer: Anthem Medicaid |
$1,360.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,086.85
|
| Rate for Payer: Cash Price |
$1,978.75
|
| Rate for Payer: Cigna Commercial |
$3,284.72
|
| Rate for Payer: First Health Commercial |
$3,759.62
|
| Rate for Payer: Humana Commercial |
$3,363.88
|
| Rate for Payer: Humana KY Medicaid |
$1,360.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,166.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,443.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,730.68
|
| Rate for Payer: PHCS Commercial |
$3,799.20
|
| Rate for Payer: United Healthcare All Payer |
$3,482.60
|
|
|
NUT M6 4933-1-701
|
Facility
|
OP
|
$502.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.83 |
| Max. Negotiated Rate |
$482.66 |
| Rate for Payer: Aetna Commercial |
$387.13
|
| Rate for Payer: Anthem Medicaid |
$172.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.16
|
| Rate for Payer: Cash Price |
$251.38
|
| Rate for Payer: Cigna Commercial |
$417.30
|
| Rate for Payer: First Health Commercial |
$477.63
|
| Rate for Payer: Humana Commercial |
$427.35
|
| Rate for Payer: Humana KY Medicaid |
$172.90
|
| Rate for Payer: Kentucky WC Medicaid |
$174.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$412.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$176.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$442.44
|
| Rate for Payer: Ohio Health Group HMO |
$377.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.91
|
| Rate for Payer: PHCS Commercial |
$482.66
|
| Rate for Payer: United Healthcare All Payer |
$442.44
|
|
|
NUT M6 4933-1-701
|
Facility
|
IP
|
$502.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.83 |
| Max. Negotiated Rate |
$482.66 |
| Rate for Payer: Aetna Commercial |
$387.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$392.16
|
| Rate for Payer: Cash Price |
$251.38
|
| Rate for Payer: Cigna Commercial |
$417.30
|
| Rate for Payer: First Health Commercial |
$477.63
|
| Rate for Payer: Humana Commercial |
$427.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$412.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$442.44
|
| Rate for Payer: Ohio Health Group HMO |
$377.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.91
|
| Rate for Payer: PHCS Commercial |
$482.66
|
| Rate for Payer: United Healthcare All Payer |
$442.44
|
|
|
NUT NYLON SBF
|
Facility
|
IP
|
$156.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$150.34 |
| Rate for Payer: Aetna Commercial |
$120.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.15
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$129.98
|
| Rate for Payer: First Health Commercial |
$148.77
|
| Rate for Payer: Humana Commercial |
$133.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.81
|
| Rate for Payer: Ohio Health Group HMO |
$117.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.05
|
| Rate for Payer: PHCS Commercial |
$150.34
|
| Rate for Payer: United Healthcare All Payer |
$137.81
|
|
|
NUT NYLON SBF
|
Facility
|
OP
|
$156.60
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$150.34 |
| Rate for Payer: Aetna Commercial |
$120.58
|
| Rate for Payer: Anthem Medicaid |
$53.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.15
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$129.98
|
| Rate for Payer: First Health Commercial |
$148.77
|
| Rate for Payer: Humana Commercial |
$133.11
|
| Rate for Payer: Humana KY Medicaid |
$53.85
|
| Rate for Payer: Kentucky WC Medicaid |
$54.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.81
|
| Rate for Payer: Ohio Health Group HMO |
$117.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$125.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$136.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$108.05
|
| Rate for Payer: PHCS Commercial |
$150.34
|
| Rate for Payer: United Healthcare All Payer |
$137.81
|
|
|
NUTRITION COUNSELING EA 15 MIN
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
NUTRITION COUNSELING EA 15 MIN
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Aetna Commercial |
$43.09
|
| Rate for Payer: Ambetter Exchange |
$30.15
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$18.77
|
| Rate for Payer: Anthem Medicaid |
$11.87
|
| Rate for Payer: Buckeye Individual/Medicaid |
$30.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$30.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$36.18
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$39.73
|
| Rate for Payer: Humana Medicaid |
$11.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.76
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$30.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30.15
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$12.11
|
| Rate for Payer: Molina Healthcare Passport |
$11.87
|
| Rate for Payer: Multiplan PHCS |
$55.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$39.20
|
| Rate for Payer: UHCCP Medicaid |
$19.71
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$11.99
|
| Rate for Payer: Wellcare Medicare Advantage |
$30.15
|
|
|
NUTRITION COUNSELING EA 15 MIN
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
HCPCS 97802
|
| Hospital Charge Code |
94200001
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.28 |
| Rate for Payer: Aetna Commercial |
$71.61
|
| Rate for Payer: Anthem Medicaid |
$31.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$72.54
|
| Rate for Payer: Cash Price |
$46.50
|
| Rate for Payer: Cigna Commercial |
$77.19
|
| Rate for Payer: First Health Commercial |
$88.35
|
| Rate for Payer: Humana Commercial |
$79.05
|
| Rate for Payer: Humana KY Medicaid |
$31.98
|
| Rate for Payer: Kentucky WC Medicaid |
$32.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$76.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$68.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$32.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$81.84
|
| Rate for Payer: Ohio Health Group HMO |
$69.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$64.17
|
| Rate for Payer: PHCS Commercial |
$89.28
|
| Rate for Payer: United Healthcare All Payer |
$81.84
|
|
|
NUVIGIL 150MG TABLET
|
Facility
|
OP
|
$96.45
|
|
|
Service Code
|
NDC 63459021530
|
| Hospital Charge Code |
25001114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$92.59 |
| Rate for Payer: Aetna Commercial |
$74.27
|
| Rate for Payer: Anthem Medicaid |
$33.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.23
|
| Rate for Payer: Cash Price |
$48.23
|
| Rate for Payer: Cigna Commercial |
$80.05
|
| Rate for Payer: First Health Commercial |
$91.63
|
| Rate for Payer: Humana Commercial |
$81.98
|
| Rate for Payer: Humana KY Medicaid |
$33.17
|
| Rate for Payer: Kentucky WC Medicaid |
$33.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$33.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.88
|
| Rate for Payer: Ohio Health Group HMO |
$72.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.55
|
| Rate for Payer: PHCS Commercial |
$92.59
|
| Rate for Payer: United Healthcare All Payer |
$84.88
|
|
|
NUVIGIL 150MG TABLET
|
Facility
|
IP
|
$96.45
|
|
|
Service Code
|
NDC 63459021530
|
| Hospital Charge Code |
25001114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.93 |
| Max. Negotiated Rate |
$92.59 |
| Rate for Payer: Aetna Commercial |
$74.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$75.23
|
| Rate for Payer: Cash Price |
$48.23
|
| Rate for Payer: Cigna Commercial |
$80.05
|
| Rate for Payer: First Health Commercial |
$91.63
|
| Rate for Payer: Humana Commercial |
$81.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$79.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$71.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$28.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$84.88
|
| Rate for Payer: Ohio Health Group HMO |
$72.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$83.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$66.55
|
| Rate for Payer: PHCS Commercial |
$92.59
|
| Rate for Payer: United Healthcare All Payer |
$84.88
|
|
|
NUVIGIL 50MG TABLET
|
Facility
|
IP
|
$60.36
|
|
|
Service Code
|
NDC 65862080530
|
| Hospital Charge Code |
25001115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$46.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.08
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.10
|
| Rate for Payer: First Health Commercial |
$57.34
|
| Rate for Payer: Humana Commercial |
$51.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.12
|
| Rate for Payer: Ohio Health Group HMO |
$45.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.65
|
| Rate for Payer: PHCS Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Payer |
$53.12
|
|
|
NUVIGIL 50MG TABLET
|
Facility
|
OP
|
$60.36
|
|
|
Service Code
|
NDC 65862080530
|
| Hospital Charge Code |
25001115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$46.48
|
| Rate for Payer: Anthem Medicaid |
$20.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$47.08
|
| Rate for Payer: Cash Price |
$30.18
|
| Rate for Payer: Cigna Commercial |
$50.10
|
| Rate for Payer: First Health Commercial |
$57.34
|
| Rate for Payer: Humana Commercial |
$51.31
|
| Rate for Payer: Humana KY Medicaid |
$20.76
|
| Rate for Payer: Kentucky WC Medicaid |
$20.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$53.12
|
| Rate for Payer: Ohio Health Group HMO |
$45.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.65
|
| Rate for Payer: PHCS Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Payer |
$53.12
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
92200011
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$128.62 |
| Max. Negotiated Rate |
$359.04 |
| Rate for Payer: Aetna Commercial |
$287.98
|
| Rate for Payer: Anthem Medicaid |
$128.62
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$291.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$310.42
|
| Rate for Payer: First Health Commercial |
$355.30
|
| Rate for Payer: Humana Commercial |
$317.90
|
| Rate for Payer: Humana KY Medicaid |
$128.62
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$129.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$306.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$276.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$131.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$329.12
|
| Rate for Payer: Ohio Health Group HMO |
$280.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$299.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$325.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$258.06
|
| Rate for Payer: PHCS Commercial |
$359.04
|
| Rate for Payer: United Healthcare All Payer |
$329.12
|
|
|
NVR CNDJ TST 1-2 STUDIES
|
Professional
|
Both
|
$374.00
|
|
|
Service Code
|
HCPCS 95907
|
| Hospital Charge Code |
92200011
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Ambetter Exchange |
$81.17
|
| Rate for Payer: Anthem Medicaid |
$74.60
|
| Rate for Payer: Buckeye Individual/Medicaid |
$81.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$81.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$97.40
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cash Price |
$187.00
|
| Rate for Payer: Cigna Commercial |
$161.92
|
| Rate for Payer: Healthspan PPO |
$94.00
|
| Rate for Payer: Humana Medicaid |
$74.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.16
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$81.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$81.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$76.09
|
| Rate for Payer: Molina Healthcare Passport |
$74.60
|
| Rate for Payer: Multiplan PHCS |
$224.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.52
|
| Rate for Payer: UHCCP Medicaid |
$130.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$75.35
|
| Rate for Payer: Wellcare Medicare Advantage |
$81.17
|
|
