|
PULMONARY ARTERIES - BILATERAL
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
320P0161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$717.72 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: Anthem Medicaid |
$411.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$717.72
|
| Rate for Payer: Healthspan PPO |
$439.20
|
| Rate for Payer: Humana Medicaid |
$411.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$106.48
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.81
|
| Rate for Payer: Molina Healthcare Passport |
$411.58
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.70
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem Medicaid |
$1,685.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$4,067.00
|
| Rate for Payer: First Health Commercial |
$4,655.00
|
| Rate for Payer: Humana Commercial |
$4,165.00
|
| Rate for Payer: Humana KY Medicaid |
$1,685.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,718.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
PULMONARY ARTERIES - BILATERAL
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
320T0161
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY ARTERIES BILATERAL
|
Facility
|
IP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000387
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY ARTERIES BILATERAL
|
Facility
|
OP
|
$4,620.00
|
|
|
Service Code
|
HCPCS 75743
|
| Hospital Charge Code |
32000387
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$4,435.20 |
| Rate for Payer: Aetna Commercial |
$3,557.40
|
| Rate for Payer: Anthem Medicaid |
$1,588.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,603.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cash Price |
$2,310.00
|
| Rate for Payer: Cigna Commercial |
$3,834.60
|
| Rate for Payer: First Health Commercial |
$4,389.00
|
| Rate for Payer: Humana Commercial |
$3,927.00
|
| Rate for Payer: Humana KY Medicaid |
$1,588.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,604.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,409.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,065.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.20
|
| Rate for Payer: PHCS Commercial |
$4,435.20
|
| Rate for Payer: United Healthcare All Payer |
$4,065.60
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$14,412.17
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$9,779.69 |
| Max. Negotiated Rate |
$14,412.17 |
| Rate for Payer: Anthem Medicaid |
$9,779.69
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,294.41
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,412.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$13,897.45
|
| Rate for Payer: Humana KY Medicaid |
$9,779.69
|
| Rate for Payer: Humana Medicare Advantage |
$10,294.41
|
| Rate for Payer: Kentucky WC Medicaid |
$9,877.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,353.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,975.28
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$16,412.58
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$11,137.11 |
| Max. Negotiated Rate |
$16,412.58 |
| Rate for Payer: Anthem Medicaid |
$11,137.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$11,723.27
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$16,412.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$15,826.41
|
| Rate for Payer: Humana KY Medicaid |
$11,137.11
|
| Rate for Payer: Humana Medicare Advantage |
$11,723.27
|
| Rate for Payer: Kentucky WC Medicaid |
$11,248.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$14,067.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,359.85
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$9,541.07
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$6,474.30 |
| Max. Negotiated Rate |
$9,541.07 |
| Rate for Payer: Anthem Medicaid |
$6,474.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,815.05
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$9,541.07
|
| Rate for Payer: CareSource Just4Me Medicare |
$9,200.32
|
| Rate for Payer: Humana KY Medicaid |
$6,474.30
|
| Rate for Payer: Humana Medicare Advantage |
$6,815.05
|
| Rate for Payer: Kentucky WC Medicaid |
$6,539.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,178.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,603.78
|
|
|
PULMOZYME SOL I 2.5ML
|
Facility
|
OP
|
$299.88
|
|
|
Service Code
|
HCPCS J7639
|
| Hospital Charge Code |
25002516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$287.88 |
| Rate for Payer: Aetna Commercial |
$230.91
|
| Rate for Payer: Anthem Medicaid |
$103.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.91
|
| Rate for Payer: Cash Price |
$149.94
|
| Rate for Payer: Cigna Commercial |
$248.90
|
| Rate for Payer: First Health Commercial |
$284.89
|
| Rate for Payer: Humana Commercial |
$254.90
|
| Rate for Payer: Humana KY Medicaid |
$103.13
|
| Rate for Payer: Kentucky WC Medicaid |
$104.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.89
|
| Rate for Payer: Ohio Health Group HMO |
$224.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.96
|
| Rate for Payer: PHCS Commercial |
$287.88
|
| Rate for Payer: United Healthcare All Payer |
$263.89
|
|
|
PULMOZYME SOL I 2.5ML
|
Facility
|
IP
|
$299.88
|
|
|
Service Code
|
HCPCS J7639
|
| Hospital Charge Code |
25002516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$287.88 |
| Rate for Payer: Aetna Commercial |
$230.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$233.91
|
| Rate for Payer: Cash Price |
$149.94
|
| Rate for Payer: Cigna Commercial |
$248.90
|
| Rate for Payer: First Health Commercial |
$284.89
|
| Rate for Payer: Humana Commercial |
$254.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$245.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$89.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$263.89
|
| Rate for Payer: Ohio Health Group HMO |
$224.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$59.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$92.96
|
| Rate for Payer: PHCS Commercial |
$287.88
|
| Rate for Payer: United Healthcare All Payer |
$263.89
|
|
|
PULM REHAB PER HOUR/SESSION
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000100
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.52
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.54
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
PULM REHAB PER HOUR/SESSION
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000100
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem Medicaid |
$80.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Humana KY Medicaid |
$80.47
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$81.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.54
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
PULM REHAB PER HR/SESS >36
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000115
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.52
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$70.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.54
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
PULM REHAB PER HR/SESS >36
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000115
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$224.64 |
| Rate for Payer: Aetna Commercial |
$180.18
|
| Rate for Payer: Anthem Medicaid |
$80.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$182.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$194.22
|
| Rate for Payer: First Health Commercial |
$222.30
|
| Rate for Payer: Humana Commercial |
$198.90
|
| Rate for Payer: Humana KY Medicaid |
$80.47
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$81.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$191.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$172.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$82.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$205.92
|
| Rate for Payer: Ohio Health Group HMO |
$175.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$46.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$30.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$72.54
|
| Rate for Payer: PHCS Commercial |
$224.64
|
| Rate for Payer: United Healthcare All Payer |
$205.92
|
|
|
PULM STRESS TEST
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
46000006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$288.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$55.26
|
| Rate for Payer: Humana Medicaid |
$26.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.14
|
| Rate for Payer: Molina Healthcare Passport |
$26.61
|
| Rate for Payer: Multiplan PHCS |
$172.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$201.60
|
| Rate for Payer: UHCCP Medicaid |
$100.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.88
|
|
|
PULM STRESS TEST
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
46000006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
PULM STRESS TEST
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
46000006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$89.28
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
PULM STRESS TEST COMPLEX
|
Facility
|
OP
|
$500.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem Medicaid |
$171.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Humana KY Medicaid |
$171.95
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$173.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$175.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
PULM STRESS TEST COMPLEX
|
Facility
|
IP
|
$500.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Aetna Commercial |
$385.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$390.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$415.00
|
| Rate for Payer: First Health Commercial |
$475.00
|
| Rate for Payer: Humana Commercial |
$425.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$410.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$369.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$440.00
|
| Rate for Payer: Ohio Health Group HMO |
$375.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$155.00
|
| Rate for Payer: PHCS Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Payer |
$440.00
|
|
|
PULM STRESS TEST COMPLEX
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Anthem Medicaid |
$126.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$500.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: Cigna Commercial |
$219.74
|
| Rate for Payer: Healthspan PPO |
$191.72
|
| Rate for Payer: Humana Medicaid |
$126.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.53
|
| Rate for Payer: Molina Healthcare Passport |
$126.01
|
| Rate for Payer: Multiplan PHCS |
$300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$350.00
|
| Rate for Payer: UHCCP Medicaid |
$175.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.27
|
|
|
PULM STRESS TEST COMPLEX(P
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
460P0007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Anthem Medicaid |
$126.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.00
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cash Price |
$56.50
|
| Rate for Payer: Cigna Commercial |
$219.74
|
| Rate for Payer: Healthspan PPO |
$191.72
|
| Rate for Payer: Humana Medicaid |
$126.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$85.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.53
|
| Rate for Payer: Molina Healthcare Passport |
$126.01
|
| Rate for Payer: Multiplan PHCS |
$67.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$79.10
|
| Rate for Payer: UHCCP Medicaid |
$39.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.27
|
|
|
PULM STRESS TEST COMPLEX(T
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
460T0007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
PULM STRESS TEST COMPLEX(T
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
460T0007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$50.31 |
| Max. Negotiated Rate |
$380.00 |
| Rate for Payer: Aetna Commercial |
$297.99
|
| Rate for Payer: Anthem Medicaid |
$133.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$301.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$321.21
|
| Rate for Payer: First Health Commercial |
$367.65
|
| Rate for Payer: Humana Commercial |
$328.95
|
| Rate for Payer: Humana KY Medicaid |
$133.09
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$134.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$317.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$285.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$135.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$340.56
|
| Rate for Payer: Ohio Health Group HMO |
$290.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$77.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$50.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$119.97
|
| Rate for Payer: PHCS Commercial |
$371.52
|
| Rate for Payer: United Healthcare All Payer |
$340.56
|
|
|
PULM STRESS TEST(P
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
460P0006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$98.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: Cigna Commercial |
$55.26
|
| Rate for Payer: Humana Medicaid |
$26.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$28.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.14
|
| Rate for Payer: Molina Healthcare Passport |
$26.61
|
| Rate for Payer: Multiplan PHCS |
$58.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$68.60
|
| Rate for Payer: UHCCP Medicaid |
$34.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.88
|
|
|
PULM STRESS TEST(T
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
460T0006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$148.20
|
| Rate for Payer: Cash Price |
$95.00
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: First Health Commercial |
$180.50
|
| Rate for Payer: Humana Commercial |
$161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$155.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$140.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$167.20
|
| Rate for Payer: Ohio Health Group HMO |
$142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$38.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$58.90
|
| Rate for Payer: PHCS Commercial |
$182.40
|
| Rate for Payer: United Healthcare All Payer |
$167.20
|
|
