|
PULMOZYME SOL I 2.5ML
|
Facility
|
OP
|
$303.77
|
|
|
Service Code
|
HCPCS J7639
|
| Hospital Charge Code |
25002516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.13 |
| Max. Negotiated Rate |
$291.62 |
| Rate for Payer: Aetna Commercial |
$233.90
|
| Rate for Payer: Anthem Medicaid |
$104.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$236.94
|
| Rate for Payer: Cash Price |
$151.88
|
| Rate for Payer: Cigna Commercial |
$252.13
|
| Rate for Payer: First Health Commercial |
$288.58
|
| Rate for Payer: Humana Commercial |
$258.20
|
| Rate for Payer: Humana KY Medicaid |
$104.47
|
| Rate for Payer: Kentucky WC Medicaid |
$105.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.32
|
| Rate for Payer: Ohio Health Group HMO |
$227.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.60
|
| Rate for Payer: PHCS Commercial |
$291.62
|
| Rate for Payer: United Healthcare All Payer |
$267.32
|
|
|
PULM REHAB PER HOUR/SESSION
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000100
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.98
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.29
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
PULM REHAB PER HOUR/SESSION
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000100
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem Medicaid |
$82.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Humana KY Medicaid |
$82.88
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$83.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.29
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
PULM REHAB PER HR/SESS >36
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000115
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem Medicaid |
$82.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Humana KY Medicaid |
$82.88
|
| Rate for Payer: Humana Medicare Advantage |
$54.88
|
| Rate for Payer: Kentucky WC Medicaid |
$83.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$65.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.29
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
PULM REHAB PER HR/SESS >36
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
HCPCS 94625
|
| Hospital Charge Code |
41000115
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$231.36 |
| Rate for Payer: Aetna Commercial |
$185.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$187.98
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$200.03
|
| Rate for Payer: First Health Commercial |
$228.95
|
| Rate for Payer: Humana Commercial |
$204.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$197.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$177.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$72.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$212.08
|
| Rate for Payer: Ohio Health Group HMO |
$180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$209.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$166.29
|
| Rate for Payer: PHCS Commercial |
$231.36
|
| Rate for Payer: United Healthcare All Payer |
$212.08
|
|
|
PULM STRESS TEST
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
46000006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
PULM STRESS TEST
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
46000006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Ambetter Exchange |
$31.85
|
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.22
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$31.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$27.14
|
| Rate for Payer: Molina Healthcare Passport |
$26.61
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$41.41
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.85
|
|
|
PULM STRESS TEST
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
46000006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
PULM STRESS TEST COMPLEX
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$504.96 |
| Rate for Payer: Aetna Commercial |
$405.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$410.28
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$436.58
|
| Rate for Payer: First Health Commercial |
$499.70
|
| Rate for Payer: Humana Commercial |
$447.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$431.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.88
|
| Rate for Payer: Ohio Health Group HMO |
$394.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.94
|
| Rate for Payer: PHCS Commercial |
$504.96
|
| Rate for Payer: United Healthcare All Payer |
$462.88
|
|
|
PULM STRESS TEST COMPLEX
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$180.89 |
| Max. Negotiated Rate |
$504.96 |
| Rate for Payer: Aetna Commercial |
$405.02
|
| Rate for Payer: Anthem Medicaid |
$180.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$410.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cigna Commercial |
$436.58
|
| Rate for Payer: First Health Commercial |
$499.70
|
| Rate for Payer: Humana Commercial |
$447.10
|
| Rate for Payer: Humana KY Medicaid |
$180.89
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$182.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$431.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$388.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$184.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$462.88
|
| Rate for Payer: Ohio Health Group HMO |
$394.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.94
|
| Rate for Payer: PHCS Commercial |
$504.96
|
| Rate for Payer: United Healthcare All Payer |
$462.88
|
|
|
PULM STRESS TEST COMPLEX
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
46000007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$315.60 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Ambetter Exchange |
$141.84
|
| Rate for Payer: Anthem Medicaid |
$126.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.21
|
| Rate for Payer: Cash Price |
$263.00
|
| Rate for Payer: Cash Price |
$263.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$141.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.84
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.53
|
| Rate for Payer: Molina Healthcare Passport |
$126.01
|
| Rate for Payer: Multiplan PHCS |
$315.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.39
|
| Rate for Payer: UHCCP Medicaid |
$184.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.84
|
|
|
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: Ambetter Exchange |
$141.84
|
| Rate for Payer: Anthem Medicaid |
$126.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$141.84
|
| Rate for Payer: Buckeye Medicare Advantage |
$141.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.21
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$141.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$141.84
|
| 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 |
$184.39
|
| Rate for Payer: UHCCP Medicaid |
$39.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$141.84
|
|
|
PULM STRESS TEST COMPLEX(T
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
460T0007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$402.82 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem Medicaid |
$142.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Humana KY Medicaid |
$142.03
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$143.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
PULM STRESS TEST COMPLEX(T
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
HCPCS 94621
|
| Hospital Charge Code |
460T0007
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$396.48 |
| Rate for Payer: Aetna Commercial |
$318.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$322.14
|
| Rate for Payer: Cash Price |
$206.50
|
| Rate for Payer: Cigna Commercial |
$342.79
|
| Rate for Payer: First Health Commercial |
$392.35
|
| Rate for Payer: Humana Commercial |
$351.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$338.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$304.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$123.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$363.44
|
| Rate for Payer: Ohio Health Group HMO |
$309.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$359.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$284.97
|
| Rate for Payer: PHCS Commercial |
$396.48
|
| Rate for Payer: United Healthcare All Payer |
$363.44
|
|
|
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 |
$58.80 |
| Rate for Payer: Ambetter Exchange |
$31.85
|
| Rate for Payer: Anthem Medicaid |
$26.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$31.85
|
| Rate for Payer: Buckeye Medicare Advantage |
$31.85
|
| Rate for Payer: CareSource Just4Me Medicare |
$38.22
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$31.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$31.85
|
| 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 |
$41.41
|
| Rate for Payer: UHCCP Medicaid |
$34.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$26.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$31.85
|
|
|
PULM STRESS TEST(T
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
460T0006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.47 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem Medicaid |
$69.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$119.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$166.74
|
| Rate for Payer: CareSource Just4Me Medicare |
$160.78
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Humana KY Medicaid |
$69.47
|
| Rate for Payer: Humana Medicare Advantage |
$119.10
|
| Rate for Payer: Kentucky WC Medicaid |
$70.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$70.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.38
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
PULM STRESS TEST(T
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 94618
|
| Hospital Charge Code |
460T0006
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$60.60 |
| Max. Negotiated Rate |
$193.92 |
| Rate for Payer: Aetna Commercial |
$155.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$157.56
|
| Rate for Payer: Cash Price |
$101.00
|
| Rate for Payer: Cigna Commercial |
$167.66
|
| Rate for Payer: First Health Commercial |
$191.90
|
| Rate for Payer: Humana Commercial |
$171.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$165.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$149.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$60.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$177.76
|
| Rate for Payer: Ohio Health Group HMO |
$151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$161.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$139.38
|
| Rate for Payer: PHCS Commercial |
$193.92
|
| Rate for Payer: United Healthcare All Payer |
$177.76
|
|
|
PULSAR STENT 5.0*100CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*100CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*150CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*150CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*30CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*30CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*40CM
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PULSAR STENT 5.0*40CM
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
