|
ELBOW ROUTINE 3V
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$281.40 |
| Rate for Payer: Aetna Commercial |
$51.91
|
| Rate for Payer: Ambetter Exchange |
$29.45
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.34
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$48.09
|
| Rate for Payer: Healthspan PPO |
$48.65
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$281.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$164.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.45
|
|
|
ELBOW ROUTINE 3V
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.70 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$140.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.61
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
ELBOW ROUTINE 3V
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
32000080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$450.24 |
| Rate for Payer: Aetna Commercial |
$361.13
|
| Rate for Payer: Anthem Medicaid |
$161.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$365.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cash Price |
$234.50
|
| Rate for Payer: Cigna Commercial |
$389.27
|
| Rate for Payer: First Health Commercial |
$445.55
|
| Rate for Payer: Humana Commercial |
$398.65
|
| Rate for Payer: Humana KY Medicaid |
$161.29
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$162.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$384.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$346.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$164.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$412.72
|
| Rate for Payer: Ohio Health Group HMO |
$351.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$323.61
|
| Rate for Payer: PHCS Commercial |
$450.24
|
| Rate for Payer: United Healthcare All Payer |
$412.72
|
|
|
ELBOW ROUTINE 3V(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
320P0080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$51.91 |
| Rate for Payer: Aetna Commercial |
$51.91
|
| Rate for Payer: Ambetter Exchange |
$29.45
|
| Rate for Payer: Anthem Medicaid |
$22.83
|
| Rate for Payer: Buckeye Individual/Medicaid |
$29.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$29.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.34
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$48.09
|
| Rate for Payer: Healthspan PPO |
$48.65
|
| Rate for Payer: Humana Medicaid |
$22.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$10.82
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$29.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$29.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$23.29
|
| Rate for Payer: Molina Healthcare Passport |
$22.83
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$38.28
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$23.06
|
| Rate for Payer: Wellcare Medicare Advantage |
$29.45
|
|
|
ELBOW ROUTINE 3V(T
|
Facility
|
IP
|
$429.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
320T0080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.70 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$128.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
ELBOW ROUTINE 3V(T
|
Facility
|
OP
|
$429.00
|
|
|
Service Code
|
HCPCS 73080
|
| Hospital Charge Code |
320T0080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$411.84 |
| Rate for Payer: Aetna Commercial |
$330.33
|
| Rate for Payer: Anthem Medicaid |
$147.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$334.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.84
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$356.07
|
| Rate for Payer: First Health Commercial |
$407.55
|
| Rate for Payer: Humana Commercial |
$364.65
|
| Rate for Payer: Humana KY Medicaid |
$147.53
|
| Rate for Payer: Humana Medicare Advantage |
$81.36
|
| Rate for Payer: Kentucky WC Medicaid |
$149.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$351.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$316.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$150.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$377.52
|
| Rate for Payer: Ohio Health Group HMO |
$321.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$373.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$296.01
|
| Rate for Payer: PHCS Commercial |
$411.84
|
| Rate for Payer: United Healthcare All Payer |
$377.52
|
|
|
ELCA 0.9MM*80
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
ELCA 0.9MM*80
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
ELCA 1.4MM
|
Facility
|
OP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem Medicaid |
$4,396.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Humana KY Medicaid |
$4,396.80
|
| Rate for Payer: Kentucky WC Medicaid |
$4,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,485.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
ELCA 1.4MM
|
Facility
|
IP
|
$12,785.10
|
|
|
Service Code
|
HCPCS C1885
|
| Hospital Charge Code |
27000283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,835.53 |
| Max. Negotiated Rate |
$12,273.70 |
| Rate for Payer: Aetna Commercial |
$9,844.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,972.38
|
| Rate for Payer: Cash Price |
$6,392.55
|
| Rate for Payer: Cigna Commercial |
$10,611.63
|
| Rate for Payer: First Health Commercial |
$12,145.84
|
| Rate for Payer: Humana Commercial |
$10,867.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,483.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,435.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,835.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,250.89
|
| Rate for Payer: Ohio Health Group HMO |
$9,588.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,228.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,123.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,821.72
|
| Rate for Payer: PHCS Commercial |
$12,273.70
|
| Rate for Payer: United Healthcare All Payer |
$11,250.89
|
|
|
ELC ANLYS IMP NUROSTIMPLSGEN(T
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 95976
|
| Hospital Charge Code |
510T0150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
ELC ANLYS IMP NUROSTIMPLSGEN(T
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 95976
|
| Hospital Charge Code |
510T0150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$134.40 |
| Rate for Payer: Aetna Commercial |
$107.80
|
| Rate for Payer: Anthem Medicaid |
$48.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$109.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$116.20
|
| Rate for Payer: First Health Commercial |
$133.00
|
| Rate for Payer: Humana Commercial |
$119.00
|
| Rate for Payer: Humana KY Medicaid |
$48.15
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$48.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$114.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$103.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$123.20
|
| Rate for Payer: Ohio Health Group HMO |
$105.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$121.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.60
|
| Rate for Payer: PHCS Commercial |
$134.40
|
| Rate for Payer: United Healthcare All Payer |
$123.20
|
|
|
ELCECTRODE DEFIB
|
Facility
|
OP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem Medicaid |
$6,878.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Humana KY Medicaid |
$6,878.00
|
| Rate for Payer: Kentucky WC Medicaid |
$6,948.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,016.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
ELCECTRODE DEFIB
|
Facility
|
IP
|
$20,000.00
|
|
|
Service Code
|
HCPCS C1895
|
| Hospital Charge Code |
27000064
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,000.00 |
| Max. Negotiated Rate |
$19,200.00 |
| Rate for Payer: Aetna Commercial |
$15,400.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,600.00
|
| Rate for Payer: Cash Price |
$10,000.00
|
| Rate for Payer: Cigna Commercial |
$16,600.00
|
| Rate for Payer: First Health Commercial |
$19,000.00
|
| Rate for Payer: Humana Commercial |
$17,000.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,400.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,760.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,000.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,600.00
|
| Rate for Payer: Ohio Health Group HMO |
$15,000.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$17,400.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,800.00
|
| Rate for Payer: PHCS Commercial |
$19,200.00
|
| Rate for Payer: United Healthcare All Payer |
$17,600.00
|
|
|
ELCTANLYS IMP NUROSTIMPLSGEN(P
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 95976
|
| Hospital Charge Code |
510P0150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Ambetter Exchange |
$35.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.06
|
| Rate for Payer: Anthem Medicaid |
$32.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.01
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Humana Medicaid |
$32.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.42
|
| Rate for Payer: Molina Healthcare Passport |
$32.76
|
| Rate for Payer: Multiplan PHCS |
$84.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.51
|
| Rate for Payer: UHCCP Medicaid |
$33.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.01
|
|
|
ELCTR ANLYS IMP NUROSTIMPLSGEN
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 95976
|
| Hospital Charge Code |
51000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Ambetter Exchange |
$35.01
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$32.06
|
| Rate for Payer: Anthem Medicaid |
$32.76
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.01
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Humana Medicaid |
$32.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$47.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$33.42
|
| Rate for Payer: Molina Healthcare Passport |
$32.76
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.51
|
| Rate for Payer: UHCCP Medicaid |
$33.66
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$33.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.01
|
|
|
ELCTR ANLYS IMP NUROSTIMPLSGEN
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 95976
|
| Hospital Charge Code |
51000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
ELCTR ANLYS IMP NUROSTIMPLSGEN
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 95976
|
| Hospital Charge Code |
51000150
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$34.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$48.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$46.52
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$34.46
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.20
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
ELDEPRYL (SELEGILINE) 5MG/1TAB
|
Facility
|
IP
|
$9.68
|
|
|
Service Code
|
NDC 60505005501
|
| Hospital Charge Code |
25000608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.55
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.20
|
| Rate for Payer: Humana Commercial |
$8.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.52
|
| Rate for Payer: Ohio Health Group HMO |
$7.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.68
|
| Rate for Payer: PHCS Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Payer |
$8.52
|
|
|
ELDEPRYL (SELEGILINE) 5MG/1TAB
|
Facility
|
OP
|
$9.68
|
|
|
Service Code
|
NDC 60505005501
|
| Hospital Charge Code |
25000608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Anthem Medicaid |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.55
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cigna Commercial |
$8.03
|
| Rate for Payer: First Health Commercial |
$9.20
|
| Rate for Payer: Humana Commercial |
$8.23
|
| Rate for Payer: Humana KY Medicaid |
$3.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.52
|
| Rate for Payer: Ohio Health Group HMO |
$7.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.68
|
| Rate for Payer: PHCS Commercial |
$9.29
|
| Rate for Payer: United Healthcare All Payer |
$8.52
|
|
|
ELEC STIM MANUAL 15 MIN
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
42000012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem Medicaid |
$46.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Humana KY Medicaid |
$46.43
|
| Rate for Payer: Kentucky WC Medicaid |
$46.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$47.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
ELEC STIM MANUAL 15 MIN
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
42000012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna Commercial |
$103.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$105.30
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$112.05
|
| Rate for Payer: First Health Commercial |
$128.25
|
| Rate for Payer: Humana Commercial |
$114.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$110.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$99.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$40.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$118.80
|
| Rate for Payer: Ohio Health Group HMO |
$101.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$117.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.15
|
| Rate for Payer: PHCS Commercial |
$129.60
|
| Rate for Payer: United Healthcare All Payer |
$118.80
|
|
|
ELEC STIM UNATTEND
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
ELEC STIM UNATTEND
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem Medicaid |
$47.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Humana KY Medicaid |
$47.46
|
| Rate for Payer: Kentucky WC Medicaid |
$47.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
|
ELEC STIM UNATTEND
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 97014
|
| Hospital Charge Code |
42000007
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$106.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$107.64
|
| Rate for Payer: Cash Price |
$69.00
|
| Rate for Payer: Cigna Commercial |
$114.54
|
| Rate for Payer: First Health Commercial |
$131.10
|
| Rate for Payer: Humana Commercial |
$117.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$113.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$101.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$121.44
|
| Rate for Payer: Ohio Health Group HMO |
$103.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$110.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$95.22
|
| Rate for Payer: PHCS Commercial |
$132.48
|
| Rate for Payer: United Healthcare All Payer |
$121.44
|
|
