|
ELECTRICAL STIM MANUAL 15 MIN
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
43000008
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
ELECTRICAL STIM MANUAL 15 MIN
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
43000008
|
|
Hospital Revenue Code
|
431
|
| Min. Negotiated Rate |
$16.64 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$98.56
|
| Rate for Payer: Anthem Medicaid |
$44.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$99.84
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cigna Commercial |
$106.24
|
| Rate for Payer: First Health Commercial |
$121.60
|
| Rate for Payer: Humana Commercial |
$108.80
|
| Rate for Payer: Humana KY Medicaid |
$44.02
|
| Rate for Payer: Kentucky WC Medicaid |
$44.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$104.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$94.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$38.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$112.64
|
| Rate for Payer: Ohio Health Group HMO |
$96.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$39.68
|
| Rate for Payer: PHCS Commercial |
$122.88
|
| Rate for Payer: United Healthcare All Payer |
$112.64
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
51000036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
51000036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$278.40 |
| Rate for Payer: Aetna Commercial |
$223.30
|
| Rate for Payer: Anthem Medicaid |
$99.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.20
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$240.70
|
| Rate for Payer: First Health Commercial |
$275.50
|
| Rate for Payer: Humana Commercial |
$246.50
|
| Rate for Payer: Humana KY Medicaid |
$99.73
|
| Rate for Payer: Kentucky WC Medicaid |
$100.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$237.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$255.20
|
| Rate for Payer: Ohio Health Group HMO |
$217.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.90
|
| Rate for Payer: PHCS Commercial |
$278.40
|
| Rate for Payer: United Healthcare All Payer |
$255.20
|
|
|
ELECTRICAL STIMULATION
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
51000036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$290.00 |
| Rate for Payer: Aetna Commercial |
$69.70
|
| Rate for Payer: Anthem Medicaid |
$21.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$290.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cash Price |
$145.00
|
| Rate for Payer: Cigna Commercial |
$51.19
|
| Rate for Payer: Healthspan PPO |
$61.39
|
| Rate for Payer: Humana Medicaid |
$21.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.62
|
| Rate for Payer: Molina Healthcare Passport |
$21.20
|
| Rate for Payer: Multiplan PHCS |
$174.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$203.00
|
| Rate for Payer: UHCCP Medicaid |
$101.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.41
|
|
|
ELECTRICAL STIMULATION(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
510P0036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$69.70
|
| Rate for Payer: Anthem Medicaid |
$21.20
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$51.19
|
| Rate for Payer: Healthspan PPO |
$61.39
|
| Rate for Payer: Humana Medicaid |
$21.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$21.62
|
| Rate for Payer: Molina Healthcare Passport |
$21.20
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.41
|
|
|
ELECTRICAL STIMULATION(T
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
510T0036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem Medicaid |
$65.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Humana KY Medicaid |
$65.34
|
| Rate for Payer: Kentucky WC Medicaid |
$66.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$66.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.90
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
ELECTRICAL STIMULATION(T
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
510T0036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.90
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
ELECTRODE 20CM EXTENSION 3382
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
ELECTRODE 20CM EXTENSION 3382
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
ELECTROLYTE PANEL
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ELECTROLYTE PANEL
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$53.13
|
| Rate for Payer: Anthem Medicaid |
$7.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$55.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$57.27
|
| Rate for Payer: First Health Commercial |
$65.55
|
| Rate for Payer: Humana Commercial |
$58.65
|
| Rate for Payer: Humana KY Medicaid |
$7.01
|
| Rate for Payer: Humana Medicare Advantage |
$7.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$56.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$50.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$60.72
|
| Rate for Payer: Ohio Health Group HMO |
$51.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.39
|
| Rate for Payer: PHCS Commercial |
$66.24
|
| Rate for Payer: United Healthcare All Payer |
$60.72
|
|
|
ELECTRONIC ANALYSIS NPG SYS(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
510P0043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Aetna Commercial |
$121.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.35
|
| Rate for Payer: Anthem Medicaid |
$62.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$158.39
|
| Rate for Payer: Healthspan PPO |
$139.73
|
| Rate for Payer: Humana Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.14
|
| Rate for Payer: Molina Healthcare Passport |
$62.88
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$122.50
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.51
|
|
|
ELECTRONIC ANALYSIS NPG SYSTEM
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
51000043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$121.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.35
|
| Rate for Payer: Anthem Medicaid |
$62.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,260.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$158.39
|
| Rate for Payer: Healthspan PPO |
$139.73
|
| Rate for Payer: Humana Medicaid |
$62.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.14
|
| Rate for Payer: Molina Healthcare Passport |
$62.88
|
| Rate for Payer: Multiplan PHCS |
$756.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$882.00
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$63.51
|
|
|
ELECTRONIC ANALYSIS NPG SYSTEM
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
51000043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.80 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$378.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.60
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
ELECTRONIC ANALYSIS NPG SYSTEM
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
51000043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,209.60 |
| Rate for Payer: Aetna Commercial |
$970.20
|
| Rate for Payer: Anthem Medicaid |
$433.31
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$83.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$117.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.01
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna Commercial |
$1,045.80
|
| Rate for Payer: First Health Commercial |
$1,197.00
|
| Rate for Payer: Humana Commercial |
$1,071.00
|
| Rate for Payer: Humana KY Medicaid |
$433.31
|
| Rate for Payer: Humana Medicare Advantage |
$83.71
|
| Rate for Payer: Kentucky WC Medicaid |
$437.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,033.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$929.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$442.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,108.80
|
| Rate for Payer: Ohio Health Group HMO |
$945.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$252.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$163.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$390.60
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR/TRANSMITTER (EG, CONTACT GROUP[S], INTERLEAVING, AMPLITUDE, PULSE WIDTH, FREQUENCY [HZ], ON/OFF CYCLING, BURST, MAGNET MODE, DOSE LOCKOUT, PATIENT SELECTABLE PARAMETERS, RESPONSIVE NEUROSTIMULATION, DETECTION ALGORITHMS, CLOSED LOOP PARAMETERS, AND PASSIVE PARAMETERS) BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL; WITH COMPLEX SPINAL CORD OR PERIPHERAL NERVE (EG, SACRAL NERVE) NEUROSTIMULATOR PULSE GENERATOR/TRANSMITTER PROGRAMMING BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL
|
Facility
|
OP
|
$117.19
|
|
|
Service Code
|
CPT 95972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$117.19 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$83.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$117.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.01
|
| Rate for Payer: Humana Medicare Advantage |
$83.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.45
|
|
|
ELECTRONIC ANALYS NPG SYSTEM(T
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
510T0043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.05 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna Commercial |
$835.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$846.30
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$900.55
|
| Rate for Payer: First Health Commercial |
$1,030.75
|
| Rate for Payer: Humana Commercial |
$922.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$889.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$800.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$954.80
|
| Rate for Payer: Ohio Health Group HMO |
$813.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.35
|
| Rate for Payer: PHCS Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare All Payer |
$954.80
|
|
|
ELECTRONIC ANALYS NPG SYSTEM(T
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
510T0043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna Commercial |
$835.45
|
| Rate for Payer: Anthem Medicaid |
$373.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$83.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$846.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$117.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$113.01
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cash Price |
$542.50
|
| Rate for Payer: Cigna Commercial |
$900.55
|
| Rate for Payer: First Health Commercial |
$1,030.75
|
| Rate for Payer: Humana Commercial |
$922.25
|
| Rate for Payer: Humana KY Medicaid |
$373.13
|
| Rate for Payer: Humana Medicare Advantage |
$83.71
|
| Rate for Payer: Kentucky WC Medicaid |
$376.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$889.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$800.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$954.80
|
| Rate for Payer: Ohio Health Group HMO |
$813.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.35
|
| Rate for Payer: PHCS Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare All Payer |
$954.80
|
|
|
ELECTRONIC COMPATIBILITY EA UN
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
30001239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.70
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
ELECTRONIC COMPATIBILITY EA UN
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
30001239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.55 |
| Max. Negotiated Rate |
$225.60 |
| Rate for Payer: Aetna Commercial |
$180.95
|
| Rate for Payer: Anthem Medicaid |
$80.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$147.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$188.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$206.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$199.40
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$195.05
|
| Rate for Payer: First Health Commercial |
$223.25
|
| Rate for Payer: Humana Commercial |
$199.75
|
| Rate for Payer: Humana KY Medicaid |
$80.82
|
| Rate for Payer: Humana Medicare Advantage |
$147.70
|
| Rate for Payer: Kentucky WC Medicaid |
$81.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$192.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$173.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$177.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$206.80
|
| Rate for Payer: Ohio Health Group HMO |
$176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$47.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.85
|
| Rate for Payer: PHCS Commercial |
$225.60
|
| Rate for Payer: United Healthcare All Payer |
$206.80
|
|
|
ELECTRON PLANNING CODE
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
33300012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$1,358.00 |
| Rate for Payer: Aetna Commercial |
$191.62
|
| Rate for Payer: Anthem Medicaid |
$149.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,358.00
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: Cigna Commercial |
$265.64
|
| Rate for Payer: Healthspan PPO |
$161.60
|
| Rate for Payer: Humana Medicaid |
$149.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.96
|
| Rate for Payer: Molina Healthcare Passport |
$149.96
|
| Rate for Payer: Multiplan PHCS |
$814.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$950.60
|
| Rate for Payer: UHCCP Medicaid |
$475.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.46
|
|
|
ELECTRON PLANNING CODE
|
Facility
|
IP
|
$1,358.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
33300012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$1,303.68 |
| Rate for Payer: Aetna Commercial |
$1,045.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,059.24
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: Cigna Commercial |
$1,127.14
|
| Rate for Payer: First Health Commercial |
$1,290.10
|
| Rate for Payer: Humana Commercial |
$1,154.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,113.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,002.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,195.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,018.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.98
|
| Rate for Payer: PHCS Commercial |
$1,303.68
|
| Rate for Payer: United Healthcare All Payer |
$1,195.04
|
|
|
ELECTRON PLANNING CODE
|
Facility
|
OP
|
$1,358.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
33300012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$176.54 |
| Max. Negotiated Rate |
$1,303.68 |
| Rate for Payer: Aetna Commercial |
$1,045.66
|
| Rate for Payer: Anthem Medicaid |
$467.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$319.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,059.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$447.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$431.35
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: Cash Price |
$679.00
|
| Rate for Payer: Cigna Commercial |
$1,127.14
|
| Rate for Payer: First Health Commercial |
$1,290.10
|
| Rate for Payer: Humana Commercial |
$1,154.30
|
| Rate for Payer: Humana KY Medicaid |
$467.02
|
| Rate for Payer: Humana Medicare Advantage |
$319.52
|
| Rate for Payer: Kentucky WC Medicaid |
$471.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,113.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,002.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$476.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,195.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,018.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$271.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$176.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$420.98
|
| Rate for Payer: PHCS Commercial |
$1,303.68
|
| Rate for Payer: United Healthcare All Payer |
$1,195.04
|
|
|
ELECTRON PLANNING CODE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 77321
|
| Hospital Charge Code |
333P0012
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$265.64 |
| Rate for Payer: Aetna Commercial |
$191.62
|
| Rate for Payer: Anthem Medicaid |
$149.96
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$265.64
|
| Rate for Payer: Healthspan PPO |
$161.60
|
| Rate for Payer: Humana Medicaid |
$149.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$59.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$152.96
|
| Rate for Payer: Molina Healthcare Passport |
$149.96
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$151.46
|
|
