|
RIVACOR 7 VR-T DF4 PRO MRI
|
Facility
|
OP
|
$35,788.50
|
|
|
Service Code
|
HCPCS C1721
|
| Hospital Charge Code |
27000003
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$4,652.50 |
| Max. Negotiated Rate |
$34,356.96 |
| Rate for Payer: Aetna Commercial |
$27,557.14
|
| Rate for Payer: Anthem Medicaid |
$12,307.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$27,915.03
|
| Rate for Payer: Cash Price |
$17,894.25
|
| Rate for Payer: Cigna Commercial |
$29,704.46
|
| Rate for Payer: First Health Commercial |
$33,999.08
|
| Rate for Payer: Humana Commercial |
$30,420.22
|
| Rate for Payer: Humana KY Medicaid |
$12,307.67
|
| Rate for Payer: Kentucky WC Medicaid |
$12,432.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$29,346.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$26,411.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$10,736.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,554.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$31,493.88
|
| Rate for Payer: Ohio Health Group HMO |
$26,841.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,157.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,652.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,094.44
|
| Rate for Payer: PHCS Commercial |
$34,356.96
|
| Rate for Payer: United Healthcare All Payer |
$31,493.88
|
|
|
R/L HC W/INJ ART/GRFT& L VEN(P
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
761P2485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$2,455.40 |
| Rate for Payer: Aetna Commercial |
$2,241.72
|
| Rate for Payer: Anthem Medicaid |
$1,247.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$660.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$2,455.40
|
| Rate for Payer: Healthspan PPO |
$1,666.22
|
| Rate for Payer: Humana Medicaid |
$1,247.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,272.57
|
| Rate for Payer: Molina Healthcare Passport |
$1,247.62
|
| Rate for Payer: Multiplan PHCS |
$396.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$462.00
|
| Rate for Payer: UHCCP Medicaid |
$231.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,260.10
|
|
|
R/L HC W/INJ ART/GRFT& L VEN(T
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
761T2485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,417.74 |
| Max. Negotiated Rate |
$17,854.08 |
| Rate for Payer: Aetna Commercial |
$14,320.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,506.44
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cigna Commercial |
$15,436.34
|
| Rate for Payer: First Health Commercial |
$17,668.10
|
| Rate for Payer: Humana Commercial |
$15,808.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,250.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,725.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,579.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,366.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,719.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,765.38
|
| Rate for Payer: PHCS Commercial |
$17,854.08
|
| Rate for Payer: United Healthcare All Payer |
$16,366.24
|
|
|
R/L HC W/INJ ART/GRFT& L VEN(T
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
761T2485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,417.74 |
| Max. Negotiated Rate |
$17,854.08 |
| Rate for Payer: Aetna Commercial |
$14,320.46
|
| Rate for Payer: Anthem Medicaid |
$6,395.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,506.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cigna Commercial |
$15,436.34
|
| Rate for Payer: First Health Commercial |
$17,668.10
|
| Rate for Payer: Humana Commercial |
$15,808.30
|
| Rate for Payer: Humana KY Medicaid |
$6,395.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,460.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,250.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,725.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,524.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,366.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,719.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,765.38
|
| Rate for Payer: PHCS Commercial |
$17,854.08
|
| Rate for Payer: United Healthcare All Payer |
$16,366.24
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
OP
|
$19,258.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
76102485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,503.54 |
| Max. Negotiated Rate |
$18,487.68 |
| Rate for Payer: Aetna Commercial |
$14,828.66
|
| Rate for Payer: Anthem Medicaid |
$6,622.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,021.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cigna Commercial |
$15,984.14
|
| Rate for Payer: First Health Commercial |
$18,295.10
|
| Rate for Payer: Humana Commercial |
$16,369.30
|
| Rate for Payer: Humana KY Medicaid |
$6,622.83
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,690.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,791.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,212.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,755.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,947.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,443.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,503.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.98
|
| Rate for Payer: PHCS Commercial |
$18,487.68
|
| Rate for Payer: United Healthcare All Payer |
$16,947.04
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
IP
|
$19,258.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
76102485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,503.54 |
| Max. Negotiated Rate |
$18,487.68 |
| Rate for Payer: Aetna Commercial |
$14,828.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,021.24
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cigna Commercial |
$15,984.14
|
| Rate for Payer: First Health Commercial |
$18,295.10
|
| Rate for Payer: Humana Commercial |
$16,369.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,791.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,212.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,777.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,947.04
|
| Rate for Payer: Ohio Health Group HMO |
$14,443.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,503.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.98
|
| Rate for Payer: PHCS Commercial |
$18,487.68
|
| Rate for Payer: United Healthcare All Payer |
$16,947.04
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Professional
|
Both
|
$19,258.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
76102485
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$602.99 |
| Max. Negotiated Rate |
$19,258.00 |
| Rate for Payer: Aetna Commercial |
$2,241.72
|
| Rate for Payer: Anthem Medicaid |
$1,247.62
|
| Rate for Payer: Buckeye Medicare Advantage |
$19,258.00
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cash Price |
$9,629.00
|
| Rate for Payer: Cigna Commercial |
$2,455.40
|
| Rate for Payer: Healthspan PPO |
$1,666.22
|
| Rate for Payer: Humana Medicaid |
$1,247.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$602.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,272.57
|
| Rate for Payer: Molina Healthcare Passport |
$1,247.62
|
| Rate for Payer: Multiplan PHCS |
$11,554.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$13,480.60
|
| Rate for Payer: UHCCP Medicaid |
$6,740.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,260.10
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
IP
|
$18,598.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
48100072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,417.74 |
| Max. Negotiated Rate |
$17,854.08 |
| Rate for Payer: Aetna Commercial |
$14,320.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,506.44
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cigna Commercial |
$15,436.34
|
| Rate for Payer: First Health Commercial |
$17,668.10
|
| Rate for Payer: Humana Commercial |
$15,808.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,250.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,725.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,579.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,366.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,719.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,765.38
|
| Rate for Payer: PHCS Commercial |
$17,854.08
|
| Rate for Payer: United Healthcare All Payer |
$16,366.24
|
|
|
R/L HC W/INJ ART/GRFT& L VENT
|
Facility
|
OP
|
$18,598.00
|
|
|
Service Code
|
HCPCS 93461
|
| Hospital Charge Code |
48100072
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,417.74 |
| Max. Negotiated Rate |
$17,854.08 |
| Rate for Payer: Aetna Commercial |
$14,320.46
|
| Rate for Payer: Anthem Medicaid |
$6,395.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,506.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cash Price |
$9,299.00
|
| Rate for Payer: Cigna Commercial |
$15,436.34
|
| Rate for Payer: First Health Commercial |
$17,668.10
|
| Rate for Payer: Humana Commercial |
$15,808.30
|
| Rate for Payer: Humana KY Medicaid |
$6,395.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$6,460.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,250.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,725.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,524.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,366.24
|
| Rate for Payer: Ohio Health Group HMO |
$13,948.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,719.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,417.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,765.38
|
| Rate for Payer: PHCS Commercial |
$17,854.08
|
| Rate for Payer: United Healthcare All Payer |
$16,366.24
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Professional
|
Both
|
$16,364.01
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
76102484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$16,364.01 |
| Rate for Payer: Aetna Commercial |
$1,957.71
|
| Rate for Payer: Anthem Medicaid |
$1,088.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$16,364.01
|
| Rate for Payer: Cash Price |
$8,182.00
|
| Rate for Payer: Cash Price |
$8,182.00
|
| Rate for Payer: Cigna Commercial |
$2,144.22
|
| Rate for Payer: Healthspan PPO |
$1,454.99
|
| Rate for Payer: Humana Medicaid |
$1,088.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,110.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,088.89
|
| Rate for Payer: Multiplan PHCS |
$9,818.41
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,454.81
|
| Rate for Payer: UHCCP Medicaid |
$5,727.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,099.78
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
OP
|
$16,364.01
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
76102484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,127.32 |
| Max. Negotiated Rate |
$15,709.45 |
| Rate for Payer: Aetna Commercial |
$12,600.29
|
| Rate for Payer: Anthem Medicaid |
$5,627.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,763.93
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,182.00
|
| Rate for Payer: Cash Price |
$8,182.00
|
| Rate for Payer: Cigna Commercial |
$13,582.13
|
| Rate for Payer: First Health Commercial |
$15,545.81
|
| Rate for Payer: Humana Commercial |
$13,909.41
|
| Rate for Payer: Humana KY Medicaid |
$5,627.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,684.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,418.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,076.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,740.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,400.33
|
| Rate for Payer: Ohio Health Group HMO |
$12,273.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,127.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,072.84
|
| Rate for Payer: PHCS Commercial |
$15,709.45
|
| Rate for Payer: United Healthcare All Payer |
$14,400.33
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
IP
|
$16,364.01
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
76102484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,127.32 |
| Max. Negotiated Rate |
$15,709.45 |
| Rate for Payer: Aetna Commercial |
$12,600.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,763.93
|
| Rate for Payer: Cash Price |
$8,182.00
|
| Rate for Payer: Cigna Commercial |
$13,582.13
|
| Rate for Payer: First Health Commercial |
$15,545.81
|
| Rate for Payer: Humana Commercial |
$13,909.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,418.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,076.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,909.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,400.33
|
| Rate for Payer: Ohio Health Group HMO |
$12,273.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,272.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,127.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,072.84
|
| Rate for Payer: PHCS Commercial |
$15,709.45
|
| Rate for Payer: United Healthcare All Payer |
$14,400.33
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
IP
|
$20,526.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
48100071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,668.38 |
| Max. Negotiated Rate |
$19,704.96 |
| Rate for Payer: Aetna Commercial |
$15,805.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,010.28
|
| Rate for Payer: Cash Price |
$10,263.00
|
| Rate for Payer: Cigna Commercial |
$17,036.58
|
| Rate for Payer: First Health Commercial |
$19,499.70
|
| Rate for Payer: Humana Commercial |
$17,447.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,831.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,148.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,157.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,062.88
|
| Rate for Payer: Ohio Health Group HMO |
$15,394.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,105.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,668.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,363.06
|
| Rate for Payer: PHCS Commercial |
$19,704.96
|
| Rate for Payer: United Healthcare All Payer |
$18,062.88
|
|
|
R/L HC W/INJ ART& L VENT IMG
|
Facility
|
OP
|
$20,526.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
48100071
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,668.38 |
| Max. Negotiated Rate |
$19,704.96 |
| Rate for Payer: Aetna Commercial |
$15,805.02
|
| Rate for Payer: Anthem Medicaid |
$7,058.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,010.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$10,263.00
|
| Rate for Payer: Cash Price |
$10,263.00
|
| Rate for Payer: Cigna Commercial |
$17,036.58
|
| Rate for Payer: First Health Commercial |
$19,499.70
|
| Rate for Payer: Humana Commercial |
$17,447.10
|
| Rate for Payer: Humana KY Medicaid |
$7,058.89
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$7,130.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,831.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,148.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,200.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,062.88
|
| Rate for Payer: Ohio Health Group HMO |
$15,394.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,105.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,668.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,363.06
|
| Rate for Payer: PHCS Commercial |
$19,704.96
|
| Rate for Payer: United Healthcare All Payer |
$18,062.88
|
|
|
R/L HC W/INJ ART& L VENT IMG(P
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
761P2484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$2,144.22 |
| Rate for Payer: Aetna Commercial |
$1,957.71
|
| Rate for Payer: Anthem Medicaid |
$1,088.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$610.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cash Price |
$305.00
|
| Rate for Payer: Cigna Commercial |
$2,144.22
|
| Rate for Payer: Healthspan PPO |
$1,454.99
|
| Rate for Payer: Humana Medicaid |
$1,088.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$546.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,110.67
|
| Rate for Payer: Molina Healthcare Passport |
$1,088.89
|
| Rate for Payer: Multiplan PHCS |
$366.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$427.00
|
| Rate for Payer: UHCCP Medicaid |
$213.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,099.78
|
|
|
R/L HC W/INJ ART& L VENT IMG(T
|
Facility
|
OP
|
$15,754.01
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
761T2484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,048.02 |
| Max. Negotiated Rate |
$15,123.85 |
| Rate for Payer: Aetna Commercial |
$12,130.59
|
| Rate for Payer: Anthem Medicaid |
$5,417.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,288.13
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$7,877.00
|
| Rate for Payer: Cash Price |
$7,877.00
|
| Rate for Payer: Cigna Commercial |
$13,075.83
|
| Rate for Payer: First Health Commercial |
$14,966.31
|
| Rate for Payer: Humana Commercial |
$13,390.91
|
| Rate for Payer: Humana KY Medicaid |
$5,417.80
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,472.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,918.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,626.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,526.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,863.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,815.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,048.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,883.74
|
| Rate for Payer: PHCS Commercial |
$15,123.85
|
| Rate for Payer: United Healthcare All Payer |
$13,863.53
|
|
|
R/L HC W/INJ ART& L VENT IMG(T
|
Facility
|
IP
|
$15,754.01
|
|
|
Service Code
|
HCPCS 93460
|
| Hospital Charge Code |
761T2484
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,048.02 |
| Max. Negotiated Rate |
$15,123.85 |
| Rate for Payer: Aetna Commercial |
$12,130.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,288.13
|
| Rate for Payer: Cash Price |
$7,877.00
|
| Rate for Payer: Cigna Commercial |
$13,075.83
|
| Rate for Payer: First Health Commercial |
$14,966.31
|
| Rate for Payer: Humana Commercial |
$13,390.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,918.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,626.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,726.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,863.53
|
| Rate for Payer: Ohio Health Group HMO |
$11,815.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,048.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,883.74
|
| Rate for Payer: PHCS Commercial |
$15,123.85
|
| Rate for Payer: United Healthcare All Payer |
$13,863.53
|
|
|
R&L HRT CATH W/VENTRICLGRPH(P
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
761P2477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$1,906.32 |
| Rate for Payer: Aetna Commercial |
$1,740.44
|
| Rate for Payer: Anthem Medicaid |
$968.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$550.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cash Price |
$275.00
|
| Rate for Payer: Cigna Commercial |
$1,906.32
|
| Rate for Payer: Healthspan PPO |
$1,293.72
|
| Rate for Payer: Humana Medicaid |
$968.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.10
|
| Rate for Payer: Molina Healthcare Passport |
$968.73
|
| Rate for Payer: Multiplan PHCS |
$330.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$385.00
|
| Rate for Payer: UHCCP Medicaid |
$192.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.42
|
|
|
R&L HRT CATH W/VENTRICLGRPH(T
|
Facility
|
IP
|
$15,606.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
761T2477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$14,981.76 |
| Rate for Payer: Aetna Commercial |
$12,016.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.68
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cigna Commercial |
$12,952.98
|
| Rate for Payer: First Health Commercial |
$14,825.70
|
| Rate for Payer: Humana Commercial |
$13,265.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,517.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,733.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,028.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,837.86
|
| Rate for Payer: PHCS Commercial |
$14,981.76
|
| Rate for Payer: United Healthcare All Payer |
$13,733.28
|
|
|
R&L HRT CATH W/VENTRICLGRPH(T
|
Facility
|
OP
|
$15,606.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
761T2477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$14,981.76 |
| Rate for Payer: Aetna Commercial |
$12,016.62
|
| Rate for Payer: Anthem Medicaid |
$5,366.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cigna Commercial |
$12,952.98
|
| Rate for Payer: First Health Commercial |
$14,825.70
|
| Rate for Payer: Humana Commercial |
$13,265.10
|
| Rate for Payer: Humana KY Medicaid |
$5,366.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,517.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,733.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,028.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,837.86
|
| Rate for Payer: PHCS Commercial |
$14,981.76
|
| Rate for Payer: United Healthcare All Payer |
$13,733.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
IP
|
$15,606.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
48100064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$14,981.76 |
| Rate for Payer: Aetna Commercial |
$12,016.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.68
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cigna Commercial |
$12,952.98
|
| Rate for Payer: First Health Commercial |
$14,825.70
|
| Rate for Payer: Humana Commercial |
$13,265.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,517.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,681.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,733.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,028.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,837.86
|
| Rate for Payer: PHCS Commercial |
$14,981.76
|
| Rate for Payer: United Healthcare All Payer |
$13,733.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
OP
|
$16,156.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
76102477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,100.28 |
| Max. Negotiated Rate |
$15,509.76 |
| Rate for Payer: Aetna Commercial |
$12,440.12
|
| Rate for Payer: Anthem Medicaid |
$5,556.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,601.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cigna Commercial |
$13,409.48
|
| Rate for Payer: First Health Commercial |
$15,348.20
|
| Rate for Payer: Humana Commercial |
$13,732.60
|
| Rate for Payer: Humana KY Medicaid |
$5,556.05
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,612.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,247.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,923.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,667.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,217.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,100.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,008.36
|
| Rate for Payer: PHCS Commercial |
$15,509.76
|
| Rate for Payer: United Healthcare All Payer |
$14,217.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Professional
|
Both
|
$16,156.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
76102477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$464.69 |
| Max. Negotiated Rate |
$16,156.00 |
| Rate for Payer: Aetna Commercial |
$1,740.44
|
| Rate for Payer: Anthem Medicaid |
$968.73
|
| Rate for Payer: Buckeye Medicare Advantage |
$16,156.00
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cigna Commercial |
$1,906.32
|
| Rate for Payer: Healthspan PPO |
$1,293.72
|
| Rate for Payer: Humana Medicaid |
$968.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$464.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$988.10
|
| Rate for Payer: Molina Healthcare Passport |
$968.73
|
| Rate for Payer: Multiplan PHCS |
$9,693.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$11,309.20
|
| Rate for Payer: UHCCP Medicaid |
$5,654.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$978.42
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
IP
|
$16,156.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
76102477
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,100.28 |
| Max. Negotiated Rate |
$15,509.76 |
| Rate for Payer: Aetna Commercial |
$12,440.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,601.68
|
| Rate for Payer: Cash Price |
$8,078.00
|
| Rate for Payer: Cigna Commercial |
$13,409.48
|
| Rate for Payer: First Health Commercial |
$15,348.20
|
| Rate for Payer: Humana Commercial |
$13,732.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,247.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,923.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,846.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,217.28
|
| Rate for Payer: Ohio Health Group HMO |
$12,117.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,100.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,008.36
|
| Rate for Payer: PHCS Commercial |
$15,509.76
|
| Rate for Payer: United Healthcare All Payer |
$14,217.28
|
|
|
R&L HRT CATH W/VENTRICLGRPHY
|
Facility
|
OP
|
$15,606.00
|
|
|
Service Code
|
HCPCS 93453
|
| Hospital Charge Code |
48100064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$14,981.76 |
| Rate for Payer: Aetna Commercial |
$12,016.62
|
| Rate for Payer: Anthem Medicaid |
$5,366.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,172.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cash Price |
$7,803.00
|
| Rate for Payer: Cigna Commercial |
$12,952.98
|
| Rate for Payer: First Health Commercial |
$14,825.70
|
| Rate for Payer: Humana Commercial |
$13,265.10
|
| Rate for Payer: Humana KY Medicaid |
$5,366.90
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$5,421.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,796.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,517.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,474.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,733.28
|
| Rate for Payer: Ohio Health Group HMO |
$11,704.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,028.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,837.86
|
| Rate for Payer: PHCS Commercial |
$14,981.76
|
| Rate for Payer: United Healthcare All Payer |
$13,733.28
|
|
