|
ARTICULEZE M HEAD 36MM +5
|
Facility
|
IP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
ARTICULEZE M HEAD 36MM +5
|
Facility
|
OP
|
$6,788.70
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,036.61 |
| Max. Negotiated Rate |
$6,517.15 |
| Rate for Payer: Aetna Commercial |
$5,227.30
|
| Rate for Payer: Anthem Medicaid |
$2,334.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,295.19
|
| Rate for Payer: Cash Price |
$3,394.35
|
| Rate for Payer: Cigna Commercial |
$5,634.62
|
| Rate for Payer: First Health Commercial |
$6,449.27
|
| Rate for Payer: Humana Commercial |
$5,770.40
|
| Rate for Payer: Humana KY Medicaid |
$2,334.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,358.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,566.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,010.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,036.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,381.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,974.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,091.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,906.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,684.20
|
| Rate for Payer: PHCS Commercial |
$6,517.15
|
| Rate for Payer: United Healthcare All Payer |
$5,974.06
|
|
|
ARTIFICIAL INSEMINATION
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
76102222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$54.27 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Aetna Commercial |
$91.49
|
| Rate for Payer: Ambetter Exchange |
$54.27
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.12
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$133.17
|
| Rate for Payer: Healthspan PPO |
$126.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.87
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$54.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.27
|
| Rate for Payer: Multiplan PHCS |
$295.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.55
|
| Rate for Payer: UHCCP Medicaid |
$172.55
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.27
|
|
|
ARTIFICIAL INSEMINATION
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
76102222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Anthem Medicaid |
$169.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$260.23
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.94
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$409.19
|
| Rate for Payer: First Health Commercial |
$468.35
|
| Rate for Payer: Humana Commercial |
$419.05
|
| Rate for Payer: Humana KY Medicaid |
$169.54
|
| Rate for Payer: Humana Medicare Advantage |
$185.88
|
| Rate for Payer: Kentucky WC Medicaid |
$171.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$223.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.84
|
| Rate for Payer: Ohio Health Group HMO |
$369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.17
|
| Rate for Payer: PHCS Commercial |
$473.28
|
| Rate for Payer: United Healthcare All Payer |
$433.84
|
|
|
ARTIFICIAL INSEMINATION
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
HCPCS 58322
|
| Hospital Charge Code |
76102222
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$147.90 |
| Max. Negotiated Rate |
$473.28 |
| Rate for Payer: Aetna Commercial |
$379.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$384.54
|
| Rate for Payer: Cash Price |
$246.50
|
| Rate for Payer: Cigna Commercial |
$409.19
|
| Rate for Payer: First Health Commercial |
$468.35
|
| Rate for Payer: Humana Commercial |
$419.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$404.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$363.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$433.84
|
| Rate for Payer: Ohio Health Group HMO |
$369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.17
|
| Rate for Payer: PHCS Commercial |
$473.28
|
| Rate for Payer: United Healthcare All Payer |
$433.84
|
|
|
ARTIFICIAL TEARS OINT (3-5GM)
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
25000260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna Commercial |
$0.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna Commercial |
$0.18
|
| Rate for Payer: First Health Commercial |
$0.21
|
| Rate for Payer: Humana Commercial |
$0.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.19
|
| Rate for Payer: Ohio Health Group HMO |
$0.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.15
|
| Rate for Payer: PHCS Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Payer |
$0.19
|
|
|
ARTIFICIAL TEARS OINT (3-5GM)
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
25000260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Aetna Commercial |
$0.17
|
| Rate for Payer: Anthem Medicaid |
$0.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$0.17
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Cigna Commercial |
$0.18
|
| Rate for Payer: First Health Commercial |
$0.21
|
| Rate for Payer: Humana Commercial |
$0.19
|
| Rate for Payer: Humana KY Medicaid |
$0.08
|
| Rate for Payer: Kentucky WC Medicaid |
$0.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$0.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$0.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$0.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$0.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$0.19
|
| Rate for Payer: Ohio Health Group HMO |
$0.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$0.15
|
| Rate for Payer: PHCS Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Payer |
$0.19
|
|
|
ART PRESSURE WAVEFORM ANALYS
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS 93050
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem Medicaid |
$41.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Humana KY Medicaid |
$41.27
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$41.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
ART PRESSURE WAVEFORM ANALYS
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 93050
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Ambetter Exchange |
$15.01
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.01
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$28.97
|
| Rate for Payer: Humana Medicaid |
$13.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$13.81
|
| Rate for Payer: Molina Healthcare Passport |
$13.54
|
| Rate for Payer: Multiplan PHCS |
$72.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$42.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$13.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.01
|
|
|
ART PRESSURE WAVEFORM ANALYS
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS 93050
|
| Hospital Charge Code |
92000016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$93.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$99.60
|
| Rate for Payer: First Health Commercial |
$114.00
|
| Rate for Payer: Humana Commercial |
$102.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$98.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$88.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$36.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$105.60
|
| Rate for Payer: Ohio Health Group HMO |
$90.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$96.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$82.80
|
| Rate for Payer: PHCS Commercial |
$115.20
|
| Rate for Payer: United Healthcare All Payer |
$105.60
|
|
|
ART PRESSURE WAVEFORM ANALYS(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93050
|
| Hospital Charge Code |
920P0016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Ambetter Exchange |
$15.01
|
| Rate for Payer: Anthem Medicaid |
$13.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$15.01
|
| Rate for Payer: Buckeye Medicare Advantage |
$15.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$18.01
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$28.97
|
| Rate for Payer: Humana Medicaid |
$13.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$11.93
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$15.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.01
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$13.81
|
| Rate for Payer: Molina Healthcare Passport |
$13.54
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$19.51
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$13.68
|
| Rate for Payer: Wellcare Medicare Advantage |
$15.01
|
|
|
ART PRESSURE WAVEFORM ANALYS(T
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS 93050
|
| Hospital Charge Code |
920T0016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
ART PRESSURE WAVEFORM ANALYS(T
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS 93050
|
| Hospital Charge Code |
920T0016
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$76.80 |
| Rate for Payer: Aetna Commercial |
$61.60
|
| Rate for Payer: Anthem Medicaid |
$27.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$22.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$62.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$31.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$30.55
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$66.40
|
| Rate for Payer: First Health Commercial |
$76.00
|
| Rate for Payer: Humana Commercial |
$68.00
|
| Rate for Payer: Humana KY Medicaid |
$27.51
|
| Rate for Payer: Humana Medicare Advantage |
$22.63
|
| Rate for Payer: Kentucky WC Medicaid |
$27.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$65.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$59.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$27.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$70.40
|
| Rate for Payer: Ohio Health Group HMO |
$60.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$69.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$55.20
|
| Rate for Payer: PHCS Commercial |
$76.80
|
| Rate for Payer: United Healthcare All Payer |
$70.40
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
921P0006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$370.93 |
| Rate for Payer: Aetna Commercial |
$347.25
|
| Rate for Payer: Ambetter Exchange |
$142.32
|
| Rate for Payer: Anthem Medicaid |
$100.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$142.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$142.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.78
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$280.04
|
| Rate for Payer: Healthspan PPO |
$370.93
|
| Rate for Payer: Humana Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$142.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.05
|
| Rate for Payer: Molina Healthcare Passport |
$100.05
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.02
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$142.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
92100006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$805.44 |
| Rate for Payer: Aetna Commercial |
$646.03
|
| Rate for Payer: Anthem Medicaid |
$288.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$654.42
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$696.37
|
| Rate for Payer: First Health Commercial |
$797.05
|
| Rate for Payer: Humana Commercial |
$713.15
|
| Rate for Payer: Humana KY Medicaid |
$288.53
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$291.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$738.32
|
| Rate for Payer: Ohio Health Group HMO |
$629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.91
|
| Rate for Payer: PHCS Commercial |
$805.44
|
| Rate for Payer: United Healthcare All Payer |
$738.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
92100006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$33.57 |
| Max. Negotiated Rate |
$503.40 |
| Rate for Payer: Aetna Commercial |
$347.25
|
| Rate for Payer: Ambetter Exchange |
$142.32
|
| Rate for Payer: Anthem Medicaid |
$100.05
|
| Rate for Payer: Buckeye Individual/Medicaid |
$142.32
|
| Rate for Payer: Buckeye Medicare Advantage |
$142.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.78
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$280.04
|
| Rate for Payer: Healthspan PPO |
$370.93
|
| Rate for Payer: Humana Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$33.57
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$142.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$102.05
|
| Rate for Payer: Molina Healthcare Passport |
$100.05
|
| Rate for Payer: Multiplan PHCS |
$503.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$185.02
|
| Rate for Payer: UHCCP Medicaid |
$293.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$101.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$142.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
921T0006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$637.44 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.92
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna Commercial |
$551.12
|
| Rate for Payer: First Health Commercial |
$630.80
|
| Rate for Payer: Humana Commercial |
$564.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.32
|
| Rate for Payer: Ohio Health Group HMO |
$498.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$458.16
|
| Rate for Payer: PHCS Commercial |
$637.44
|
| Rate for Payer: United Healthcare All Payer |
$584.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
92100006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$251.70 |
| Max. Negotiated Rate |
$805.44 |
| Rate for Payer: Aetna Commercial |
$646.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$654.42
|
| Rate for Payer: Cash Price |
$419.50
|
| Rate for Payer: Cigna Commercial |
$696.37
|
| Rate for Payer: First Health Commercial |
$797.05
|
| Rate for Payer: Humana Commercial |
$713.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$738.32
|
| Rate for Payer: Ohio Health Group HMO |
$629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$729.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.91
|
| Rate for Payer: PHCS Commercial |
$805.44
|
| Rate for Payer: United Healthcare All Payer |
$738.32
|
|
|
ART STUDY W/TREADMILL EXERCISE
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
HCPCS 93924
|
| Hospital Charge Code |
921T0006
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$637.44 |
| Rate for Payer: Aetna Commercial |
$511.28
|
| Rate for Payer: Anthem Medicaid |
$228.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$517.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cigna Commercial |
$551.12
|
| Rate for Payer: First Health Commercial |
$630.80
|
| Rate for Payer: Humana Commercial |
$564.40
|
| Rate for Payer: Humana KY Medicaid |
$228.35
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$230.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$544.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$490.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$584.32
|
| Rate for Payer: Ohio Health Group HMO |
$498.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$531.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$458.16
|
| Rate for Payer: PHCS Commercial |
$637.44
|
| Rate for Payer: United Healthcare All Payer |
$584.32
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
48000104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem Medicaid |
$254.49
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Humana KY Medicaid |
$254.49
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$257.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$259.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$510.60
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
|
ART TEST W/O TREADMILL EXER.
|
Professional
|
Both
|
$861.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$516.60 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Ambetter Exchange |
$116.24
|
| Rate for Payer: Anthem Medicaid |
$91.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$116.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$116.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$139.49
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$233.77
|
| Rate for Payer: Healthspan PPO |
$301.92
|
| Rate for Payer: Humana Medicaid |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$116.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.00
|
| Rate for Payer: Molina Healthcare Passport |
$91.18
|
| Rate for Payer: Multiplan PHCS |
$516.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$151.11
|
| Rate for Payer: UHCCP Medicaid |
$301.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.24
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$826.56 |
| Rate for Payer: Aetna Commercial |
$662.97
|
| Rate for Payer: Anthem Medicaid |
$296.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$714.63
|
| Rate for Payer: First Health Commercial |
$817.95
|
| Rate for Payer: Humana Commercial |
$731.85
|
| Rate for Payer: Humana KY Medicaid |
$296.10
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$299.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$635.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$302.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$757.68
|
| Rate for Payer: Ohio Health Group HMO |
$645.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.09
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
92100005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$258.30 |
| Max. Negotiated Rate |
$826.56 |
| Rate for Payer: Aetna Commercial |
$662.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$714.63
|
| Rate for Payer: First Health Commercial |
$817.95
|
| Rate for Payer: Humana Commercial |
$731.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$706.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$635.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$757.68
|
| Rate for Payer: Ohio Health Group HMO |
$645.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$749.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.09
|
| Rate for Payer: PHCS Commercial |
$826.56
|
| Rate for Payer: United Healthcare All Payer |
$757.68
|
|
|
ART TEST W/O TREADMILL EXER.
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
48000104
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$710.40 |
| Rate for Payer: Aetna Commercial |
$569.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$577.20
|
| Rate for Payer: Cash Price |
$370.00
|
| Rate for Payer: Cigna Commercial |
$614.20
|
| Rate for Payer: First Health Commercial |
$703.00
|
| Rate for Payer: Humana Commercial |
$629.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$606.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$546.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$651.20
|
| Rate for Payer: Ohio Health Group HMO |
$555.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$592.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$510.60
|
| Rate for Payer: PHCS Commercial |
$710.40
|
| Rate for Payer: United Healthcare All Payer |
$651.20
|
|
|
ART TEST W/O TREADMILL EXER.(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93923
|
| Hospital Charge Code |
921P0005
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$301.92 |
| Rate for Payer: Aetna Commercial |
$282.64
|
| Rate for Payer: Ambetter Exchange |
$116.24
|
| Rate for Payer: Anthem Medicaid |
$91.18
|
| Rate for Payer: Buckeye Individual/Medicaid |
$116.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$116.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$139.49
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$233.77
|
| Rate for Payer: Healthspan PPO |
$301.92
|
| Rate for Payer: Humana Medicaid |
$91.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$116.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$116.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$93.00
|
| Rate for Payer: Molina Healthcare Passport |
$91.18
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$151.11
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$92.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$116.24
|
|
