|
ELEC STIM UNATTEND
|
Facility
|
OP
|
$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 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 UNATTENDED
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS 97014
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| 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 UNATTENDED
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| 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 UNATTENDED
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
HCPCS G0283
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| 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 UNATTENDED
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
HCPCS 97014
|
| Hospital Charge Code |
43000004
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
ELECTRICAL STIM MANUAL 15 MIN
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
43000008
|
|
Hospital Revenue Code
|
431
|
| 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
|
|
|
ELECTRICAL STIM MANUAL 15 MIN
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
HCPCS 97032
|
| Hospital Charge Code |
43000008
|
|
Hospital Revenue Code
|
431
|
| 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
|
|
|
ELECTRICAL STIMULATION
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
51000036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.00 |
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
$87.00 |
| 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 |
$232.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.10
|
| 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 |
$174.00 |
| Rate for Payer: Aetna Commercial |
$69.70
|
| Rate for Payer: Ambetter Exchange |
$61.22
|
| Rate for Payer: Anthem Medicaid |
$21.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$61.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.22
|
| 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 |
$79.59
|
| Rate for Payer: UHCCP Medicaid |
$101.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.22
|
|
|
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 |
$79.59 |
| Rate for Payer: Aetna Commercial |
$69.70
|
| Rate for Payer: Ambetter Exchange |
$61.22
|
| Rate for Payer: Anthem Medicaid |
$21.20
|
| Rate for Payer: Buckeye Individual/Medicaid |
$61.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$61.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$73.46
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$61.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$61.22
|
| 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 |
$79.59
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$61.22
|
|
|
ELECTRICAL STIMULATION(T
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 95873
|
| Hospital Charge Code |
510T0036
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.00 |
| 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 |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| 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 |
$57.00 |
| 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 |
$152.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$131.10
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
|
ELECTRODE 20CM EXTENSION 3382
|
Facility
|
OP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem Medicaid |
$1,655.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Humana KY Medicaid |
$1,655.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,671.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,688.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
ELECTRODE 20CM EXTENSION 3382
|
Facility
|
IP
|
$4,812.50
|
|
|
Service Code
|
HCPCS C1883
|
| Hospital Charge Code |
27000063
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,443.75 |
| Max. Negotiated Rate |
$4,620.00 |
| Rate for Payer: Aetna Commercial |
$3,705.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,753.75
|
| Rate for Payer: Cash Price |
$2,406.25
|
| Rate for Payer: Cigna Commercial |
$3,994.38
|
| Rate for Payer: First Health Commercial |
$4,571.88
|
| Rate for Payer: Humana Commercial |
$4,090.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,946.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,551.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,443.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,235.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,609.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,186.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,320.62
|
| Rate for Payer: PHCS Commercial |
$4,620.00
|
| Rate for Payer: United Healthcare All Payer |
$4,235.00
|
|
|
ELECTROLYTE PANEL
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$21.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
ELECTROLYTE PANEL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS 80051
|
| Hospital Charge Code |
30000007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$70.08 |
| Rate for Payer: Aetna Commercial |
$56.21
|
| Rate for Payer: Anthem Medicaid |
$7.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$58.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$7.01
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cash Price |
$36.50
|
| Rate for Payer: Cigna Commercial |
$60.59
|
| Rate for Payer: First Health Commercial |
$69.35
|
| Rate for Payer: Humana Commercial |
$62.05
|
| 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 |
$59.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$53.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$64.24
|
| Rate for Payer: Ohio Health Group HMO |
$54.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.37
|
| Rate for Payer: PHCS Commercial |
$70.08
|
| Rate for Payer: United Healthcare All Payer |
$64.24
|
|
|
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 |
$158.39 |
| Rate for Payer: Aetna Commercial |
$121.71
|
| Rate for Payer: Ambetter Exchange |
$37.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.35
|
| Rate for Payer: Anthem Medicaid |
$63.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.82
|
| 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 |
$63.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.95
|
| Rate for Payer: Molina Healthcare Passport |
$63.68
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.55
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.35
|
|
|
ELECTRONIC ANALYSIS NPG SYSTEM
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
51000043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.81 |
| 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 |
$84.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$982.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.49
|
| 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 |
$84.81
|
| 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 |
$101.77
|
| 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 |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.40
|
| Rate for Payer: PHCS Commercial |
$1,209.60
|
| Rate for Payer: United Healthcare All Payer |
$1,108.80
|
|
|
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 |
$756.00 |
| Rate for Payer: Aetna Commercial |
$121.71
|
| Rate for Payer: Ambetter Exchange |
$37.35
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.35
|
| Rate for Payer: Anthem Medicaid |
$63.68
|
| Rate for Payer: Buckeye Individual/Medicaid |
$37.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$37.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$44.82
|
| 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 |
$63.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$93.66
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$37.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.35
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$64.95
|
| Rate for Payer: Molina Healthcare Passport |
$63.68
|
| Rate for Payer: Multiplan PHCS |
$756.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.55
|
| Rate for Payer: UHCCP Medicaid |
$29.77
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$64.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$37.35
|
|
|
ELECTRONIC ANALYSIS NPG SYSTEM
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
HCPCS 95972
|
| Hospital Charge Code |
51000043
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$378.00 |
| 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 |
$1,008.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,096.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$869.40
|
| 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
|
$118.73
|
|
|
Service Code
|
CPT 95972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$118.73 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$84.81
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.49
|
| Rate for Payer: Humana Medicare Advantage |
$84.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$101.77
|
|
|
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 |
$84.81 |
| 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 |
$84.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$846.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$118.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$114.49
|
| 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 |
$84.81
|
| 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 |
$101.77
|
| 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 |
$868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$943.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$748.65
|
| Rate for Payer: PHCS Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare All Payer |
$954.80
|
|
|
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 |
$325.50 |
| 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 |
$868.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$943.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$748.65
|
| Rate for Payer: PHCS Commercial |
$1,041.60
|
| Rate for Payer: United Healthcare All Payer |
$954.80
|
|
|
ELECTRONIC COMPATIBILITY EA UN
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
HCPCS 86923
|
| Hospital Charge Code |
30001239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.33 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$192.50
|
| Rate for Payer: Anthem Medicaid |
$158.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$200.75
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$221.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$158.33
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$207.50
|
| Rate for Payer: First Health Commercial |
$237.50
|
| Rate for Payer: Humana Commercial |
$212.50
|
| Rate for Payer: Humana KY Medicaid |
$158.33
|
| Rate for Payer: Humana Medicare Advantage |
$158.33
|
| Rate for Payer: Kentucky WC Medicaid |
$159.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$205.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$184.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$161.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$220.00
|
| Rate for Payer: Ohio Health Group HMO |
$187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$217.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$172.50
|
| Rate for Payer: PHCS Commercial |
$240.00
|
| Rate for Payer: United Healthcare All Payer |
$220.00
|
|
