|
HSG CATH 7FR
|
Facility
|
IP
|
$483.12
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$463.80 |
| Rate for Payer: Aetna Commercial |
$372.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.83
|
| Rate for Payer: Cash Price |
$241.56
|
| Rate for Payer: Cigna Commercial |
$400.99
|
| Rate for Payer: First Health Commercial |
$458.96
|
| Rate for Payer: Humana Commercial |
$410.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.15
|
| Rate for Payer: Ohio Health Group HMO |
$362.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.35
|
| Rate for Payer: PHCS Commercial |
$463.80
|
| Rate for Payer: United Healthcare All Payer |
$425.15
|
|
|
HSG CATH 7FR
|
Facility
|
OP
|
$483.12
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$463.80 |
| Rate for Payer: Aetna Commercial |
$372.00
|
| Rate for Payer: Anthem Medicaid |
$166.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.83
|
| Rate for Payer: Cash Price |
$241.56
|
| Rate for Payer: Cigna Commercial |
$400.99
|
| Rate for Payer: First Health Commercial |
$458.96
|
| Rate for Payer: Humana Commercial |
$410.65
|
| Rate for Payer: Humana KY Medicaid |
$166.14
|
| Rate for Payer: Kentucky WC Medicaid |
$167.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.15
|
| Rate for Payer: Ohio Health Group HMO |
$362.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.35
|
| Rate for Payer: PHCS Commercial |
$463.80
|
| Rate for Payer: United Healthcare All Payer |
$425.15
|
|
|
HSG/SIS CATHETER 5F
|
Facility
|
OP
|
$483.12
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$463.80 |
| Rate for Payer: Aetna Commercial |
$372.00
|
| Rate for Payer: Anthem Medicaid |
$166.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.83
|
| Rate for Payer: Cash Price |
$241.56
|
| Rate for Payer: Cigna Commercial |
$400.99
|
| Rate for Payer: First Health Commercial |
$458.96
|
| Rate for Payer: Humana Commercial |
$410.65
|
| Rate for Payer: Humana KY Medicaid |
$166.14
|
| Rate for Payer: Kentucky WC Medicaid |
$167.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$169.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.15
|
| Rate for Payer: Ohio Health Group HMO |
$362.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.35
|
| Rate for Payer: PHCS Commercial |
$463.80
|
| Rate for Payer: United Healthcare All Payer |
$425.15
|
|
|
HSG/SIS CATHETER 5F
|
Facility
|
IP
|
$483.12
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$463.80 |
| Rate for Payer: Aetna Commercial |
$372.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$376.83
|
| Rate for Payer: Cash Price |
$241.56
|
| Rate for Payer: Cigna Commercial |
$400.99
|
| Rate for Payer: First Health Commercial |
$458.96
|
| Rate for Payer: Humana Commercial |
$410.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$396.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$356.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$144.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$425.15
|
| Rate for Payer: Ohio Health Group HMO |
$362.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$333.35
|
| Rate for Payer: PHCS Commercial |
$463.80
|
| Rate for Payer: United Healthcare All Payer |
$425.15
|
|
|
HSV 1 & 2 PCR EACH
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001379
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$35.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$49.13
|
| Rate for Payer: CareSource Just4Me Medicare |
$35.09
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Humana KY Medicaid |
$35.09
|
| Rate for Payer: Humana Medicare Advantage |
$35.09
|
| Rate for Payer: Kentucky WC Medicaid |
$35.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$42.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
HSV 1 & 2 PCR EACH
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001379
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Ambetter Exchange |
$35.09
|
| Rate for Payer: Buckeye Individual/Medicaid |
$35.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$35.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$30.93
|
| Rate for Payer: Healthspan PPO |
$36.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$35.09
|
| Rate for Payer: Multiplan PHCS |
$165.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$45.62
|
| Rate for Payer: UHCCP Medicaid |
$96.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$21.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$35.09
|
|
|
HSV 1 & 2 PCR EACH
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
30001379
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$212.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$221.63
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: First Health Commercial |
$262.20
|
| Rate for Payer: Humana Commercial |
$234.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$226.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$203.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$82.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$242.88
|
| Rate for Payer: Ohio Health Group HMO |
$207.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$220.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$190.44
|
| Rate for Payer: PHCS Commercial |
$264.96
|
| Rate for Payer: United Healthcare All Payer |
$242.88
|
|
|
HSV II AB IGM S
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
30001170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem Medicaid |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$14.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$20.15
|
| Rate for Payer: CareSource Just4Me Medicare |
$14.39
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Humana KY Medicaid |
$14.39
|
| Rate for Payer: Humana Medicare Advantage |
$14.39
|
| Rate for Payer: Kentucky WC Medicaid |
$14.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$17.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$14.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HSV II AB IGM S
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 86694
|
| Hospital Charge Code |
30001170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$91.54
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$94.62
|
| Rate for Payer: First Health Commercial |
$108.30
|
| Rate for Payer: Humana Commercial |
$96.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$93.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$100.32
|
| Rate for Payer: Ohio Health Group HMO |
$85.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$78.66
|
| Rate for Payer: PHCS Commercial |
$109.44
|
| Rate for Payer: United Healthcare All Payer |
$100.32
|
|
|
HTLV I AB S
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
30001166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$45.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.88
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
HTLV I AB S
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS 86687
|
| Hospital Charge Code |
30001166
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$145.92 |
| Rate for Payer: Aetna Commercial |
$117.04
|
| Rate for Payer: Anthem Medicaid |
$9.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$122.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$12.73
|
| Rate for Payer: CareSource Just4Me Medicare |
$9.09
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cigna Commercial |
$126.16
|
| Rate for Payer: First Health Commercial |
$144.40
|
| Rate for Payer: Humana Commercial |
$129.20
|
| Rate for Payer: Humana KY Medicaid |
$9.09
|
| Rate for Payer: Humana Medicare Advantage |
$9.09
|
| Rate for Payer: Kentucky WC Medicaid |
$9.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$124.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$112.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$9.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$133.76
|
| Rate for Payer: Ohio Health Group HMO |
$114.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$121.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$132.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$104.88
|
| Rate for Payer: PHCS Commercial |
$145.92
|
| Rate for Payer: United Healthcare All Payer |
$133.76
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
OP
|
$5,384.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
34000018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$5,168.64 |
| Rate for Payer: Aetna Commercial |
$4,145.68
|
| Rate for Payer: Anthem Medicaid |
$1,851.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,199.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$2,692.00
|
| Rate for Payer: Cash Price |
$2,692.00
|
| Rate for Payer: Cigna Commercial |
$4,468.72
|
| Rate for Payer: First Health Commercial |
$5,114.80
|
| Rate for Payer: Humana Commercial |
$4,576.40
|
| Rate for Payer: Humana KY Medicaid |
$1,851.56
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,870.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,414.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,973.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,888.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,737.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,038.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,684.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,714.96
|
| Rate for Payer: PHCS Commercial |
$5,168.64
|
| Rate for Payer: United Healthcare All Payer |
$4,737.92
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Facility
|
IP
|
$5,384.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
34000018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,615.20 |
| Max. Negotiated Rate |
$5,168.64 |
| Rate for Payer: Aetna Commercial |
$4,145.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,199.52
|
| Rate for Payer: Cash Price |
$2,692.00
|
| Rate for Payer: Cigna Commercial |
$4,468.72
|
| Rate for Payer: First Health Commercial |
$5,114.80
|
| Rate for Payer: Humana Commercial |
$4,576.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,414.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,973.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,615.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,737.92
|
| Rate for Payer: Ohio Health Group HMO |
$4,038.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,307.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,684.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,714.96
|
| Rate for Payer: PHCS Commercial |
$5,168.64
|
| Rate for Payer: United Healthcare All Payer |
$4,737.92
|
|
|
HT MUSCLE IMAGE SPECT MULT
|
Professional
|
Both
|
$5,384.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
34000018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$87.78 |
| Max. Negotiated Rate |
$3,230.40 |
| Rate for Payer: Aetna Commercial |
$701.44
|
| Rate for Payer: Ambetter Exchange |
$377.61
|
| Rate for Payer: Anthem Medicaid |
$273.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$377.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$377.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$453.13
|
| Rate for Payer: Cash Price |
$2,692.00
|
| Rate for Payer: Cash Price |
$2,692.00
|
| Rate for Payer: Cigna Commercial |
$590.49
|
| Rate for Payer: Healthspan PPO |
$448.66
|
| Rate for Payer: Humana Medicaid |
$273.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$377.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.96
|
| Rate for Payer: Molina Healthcare Passport |
$273.49
|
| Rate for Payer: Multiplan PHCS |
$3,230.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.89
|
| Rate for Payer: UHCCP Medicaid |
$1,884.40
|
| Rate for Payer: United Healthcare Non-Options |
$459.23
|
| Rate for Payer: United Healthcare Options |
$459.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$377.61
|
|
|
HT MUSCLE IMAGE SPECT MULT(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
340P0018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$701.44 |
| Rate for Payer: Aetna Commercial |
$701.44
|
| Rate for Payer: Ambetter Exchange |
$377.61
|
| Rate for Payer: Anthem Medicaid |
$273.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$377.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$377.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$453.13
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$590.49
|
| Rate for Payer: Healthspan PPO |
$448.66
|
| Rate for Payer: Humana Medicaid |
$273.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$87.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$377.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$377.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$278.96
|
| Rate for Payer: Molina Healthcare Passport |
$273.49
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$490.89
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: United Healthcare Non-Options |
$459.23
|
| Rate for Payer: United Healthcare Options |
$459.23
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$377.61
|
|
|
HT MUSCLE IMAGE SPECT MULT(T
|
Facility
|
IP
|
$5,209.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
340T0018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,562.70 |
| Max. Negotiated Rate |
$5,000.64 |
| Rate for Payer: Aetna Commercial |
$4,010.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.02
|
| Rate for Payer: Cash Price |
$2,604.50
|
| Rate for Payer: Cigna Commercial |
$4,323.47
|
| Rate for Payer: First Health Commercial |
$4,948.55
|
| Rate for Payer: Humana Commercial |
$4,427.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,271.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,562.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,531.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.21
|
| Rate for Payer: PHCS Commercial |
$5,000.64
|
| Rate for Payer: United Healthcare All Payer |
$4,583.92
|
|
|
HT MUSCLE IMAGE SPECT MULT(T
|
Facility
|
OP
|
$5,209.00
|
|
|
Service Code
|
HCPCS 78452
|
| Hospital Charge Code |
340T0018
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$5,000.64 |
| Rate for Payer: Aetna Commercial |
$4,010.93
|
| Rate for Payer: Anthem Medicaid |
$1,791.38
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$2,604.50
|
| Rate for Payer: Cash Price |
$2,604.50
|
| Rate for Payer: Cigna Commercial |
$4,323.47
|
| Rate for Payer: First Health Commercial |
$4,948.55
|
| Rate for Payer: Humana Commercial |
$4,427.65
|
| Rate for Payer: Humana KY Medicaid |
$1,791.38
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,271.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,827.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,583.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,906.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,167.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,531.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,594.21
|
| Rate for Payer: PHCS Commercial |
$5,000.64
|
| Rate for Payer: United Healthcare All Payer |
$4,583.92
|
|
|
HT MUSCLE IMAGE SPECT SING
|
Professional
|
Both
|
$3,478.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
34000017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$74.45 |
| Max. Negotiated Rate |
$2,086.80 |
| Rate for Payer: Aetna Commercial |
$336.72
|
| Rate for Payer: Ambetter Exchange |
$274.80
|
| Rate for Payer: Anthem Medicaid |
$161.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$274.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$274.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.76
|
| Rate for Payer: Cash Price |
$1,739.00
|
| Rate for Payer: Cash Price |
$1,739.00
|
| Rate for Payer: Cigna Commercial |
$484.11
|
| Rate for Payer: Healthspan PPO |
$264.21
|
| Rate for Payer: Humana Medicaid |
$161.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$274.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.76
|
| Rate for Payer: Molina Healthcare Passport |
$161.53
|
| Rate for Payer: Multiplan PHCS |
$2,086.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$357.24
|
| Rate for Payer: UHCCP Medicaid |
$1,217.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$274.80
|
|
|
HT MUSCLE IMAGE SPECT SING
|
Facility
|
OP
|
$3,478.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
34000017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,196.08 |
| Max. Negotiated Rate |
$3,338.88 |
| Rate for Payer: Aetna Commercial |
$2,678.06
|
| Rate for Payer: Anthem Medicaid |
$1,196.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$1,739.00
|
| Rate for Payer: Cash Price |
$1,739.00
|
| Rate for Payer: Cigna Commercial |
$2,886.74
|
| Rate for Payer: First Health Commercial |
$3,304.10
|
| Rate for Payer: Humana Commercial |
$2,956.30
|
| Rate for Payer: Humana KY Medicaid |
$1,196.08
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,208.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,220.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,025.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,399.82
|
| Rate for Payer: PHCS Commercial |
$3,338.88
|
| Rate for Payer: United Healthcare All Payer |
$3,060.64
|
|
|
HT MUSCLE IMAGE SPECT SING
|
Facility
|
IP
|
$3,478.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
34000017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,043.40 |
| Max. Negotiated Rate |
$3,338.88 |
| Rate for Payer: Aetna Commercial |
$2,678.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.84
|
| Rate for Payer: Cash Price |
$1,739.00
|
| Rate for Payer: Cigna Commercial |
$2,886.74
|
| Rate for Payer: First Health Commercial |
$3,304.10
|
| Rate for Payer: Humana Commercial |
$2,956.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,782.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,025.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,399.82
|
| Rate for Payer: PHCS Commercial |
$3,338.88
|
| Rate for Payer: United Healthcare All Payer |
$3,060.64
|
|
|
HT MUSCLE IMAGE SPECT SING(P
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
340P0017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$484.11 |
| Rate for Payer: Aetna Commercial |
$336.72
|
| Rate for Payer: Ambetter Exchange |
$274.80
|
| Rate for Payer: Anthem Medicaid |
$161.53
|
| Rate for Payer: Buckeye Individual/Medicaid |
$274.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$274.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$329.76
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$484.11
|
| Rate for Payer: Healthspan PPO |
$264.21
|
| Rate for Payer: Humana Medicaid |
$161.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.45
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$274.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$274.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.76
|
| Rate for Payer: Molina Healthcare Passport |
$161.53
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$357.24
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$163.15
|
| Rate for Payer: Wellcare Medicare Advantage |
$274.80
|
|
|
HT MUSCLE IMAGE SPECT SING(T
|
Facility
|
OP
|
$3,303.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
340T0017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$1,135.90 |
| Max. Negotiated Rate |
$3,170.88 |
| Rate for Payer: Aetna Commercial |
$2,543.31
|
| Rate for Payer: Anthem Medicaid |
$1,135.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,206.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,576.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,688.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,628.42
|
| Rate for Payer: Cash Price |
$1,651.50
|
| Rate for Payer: Cash Price |
$1,651.50
|
| Rate for Payer: Cigna Commercial |
$2,741.49
|
| Rate for Payer: First Health Commercial |
$3,137.85
|
| Rate for Payer: Humana Commercial |
$2,807.55
|
| Rate for Payer: Humana KY Medicaid |
$1,135.90
|
| Rate for Payer: Humana Medicare Advantage |
$1,206.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,158.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,477.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,642.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,873.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,279.07
|
| Rate for Payer: PHCS Commercial |
$3,170.88
|
| Rate for Payer: United Healthcare All Payer |
$2,906.64
|
|
|
HT MUSCLE IMAGE SPECT SING(T
|
Facility
|
IP
|
$3,303.00
|
|
|
Service Code
|
HCPCS 78451
|
| Hospital Charge Code |
340T0017
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$990.90 |
| Max. Negotiated Rate |
$3,170.88 |
| Rate for Payer: Aetna Commercial |
$2,543.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,576.34
|
| Rate for Payer: Cash Price |
$1,651.50
|
| Rate for Payer: Cigna Commercial |
$2,741.49
|
| Rate for Payer: First Health Commercial |
$3,137.85
|
| Rate for Payer: Humana Commercial |
$2,807.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,477.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,642.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,873.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,279.07
|
| Rate for Payer: PHCS Commercial |
$3,170.88
|
| Rate for Payer: United Healthcare All Payer |
$2,906.64
|
|
|
HT WHISPER MS 190CM
|
Facility
|
OP
|
$1,500.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,155.15
|
| Rate for Payer: Anthem Medicaid |
$515.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.16
|
| Rate for Payer: Cash Price |
$750.10
|
| Rate for Payer: Cigna Commercial |
$1,245.17
|
| Rate for Payer: First Health Commercial |
$1,425.19
|
| Rate for Payer: Humana Commercial |
$1,275.17
|
| Rate for Payer: Humana KY Medicaid |
$515.92
|
| Rate for Payer: Kentucky WC Medicaid |
$521.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.14
|
| Rate for Payer: PHCS Commercial |
$1,440.19
|
| Rate for Payer: United Healthcare All Payer |
$1,320.18
|
|
|
HT WHISPER MS 190CM
|
Facility
|
IP
|
$1,500.20
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$1,440.19 |
| Rate for Payer: Aetna Commercial |
$1,155.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.16
|
| Rate for Payer: Cash Price |
$750.10
|
| Rate for Payer: Cigna Commercial |
$1,245.17
|
| Rate for Payer: First Health Commercial |
$1,425.19
|
| Rate for Payer: Humana Commercial |
$1,275.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.14
|
| Rate for Payer: PHCS Commercial |
$1,440.19
|
| Rate for Payer: United Healthcare All Payer |
$1,320.18
|
|
