|
TECHNETIUM THYROID
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$97.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cigna Commercial |
$620.84
|
| Rate for Payer: First Health Commercial |
$710.60
|
| Rate for Payer: Humana Commercial |
$635.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$613.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$552.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$224.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$658.24
|
| Rate for Payer: Ohio Health Group HMO |
$561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$149.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$97.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$231.88
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
TECHNETIUM THYROID(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
340P0001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$340.80 |
| Rate for Payer: Anthem Medicaid |
$160.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$340.80
|
| Rate for Payer: Healthspan PPO |
$231.09
|
| Rate for Payer: Humana Medicaid |
$160.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$19.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.14
|
| Rate for Payer: Molina Healthcare Passport |
$160.92
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.53
|
|
|
TECHNETIUM THYROID(T
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
340T0001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$460.46
|
| Rate for Payer: Anthem Medicaid |
$205.65
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$356.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$499.32
|
| Rate for Payer: CareSource Just4Me Medicare |
$481.49
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$496.34
|
| Rate for Payer: First Health Commercial |
$568.10
|
| Rate for Payer: Humana Commercial |
$508.30
|
| Rate for Payer: Humana KY Medicaid |
$205.65
|
| Rate for Payer: Humana Medicare Advantage |
$356.66
|
| Rate for Payer: Kentucky WC Medicaid |
$207.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$490.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$441.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$427.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$209.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$526.24
|
| Rate for Payer: Ohio Health Group HMO |
$448.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.38
|
| Rate for Payer: PHCS Commercial |
$574.08
|
| Rate for Payer: United Healthcare All Payer |
$526.24
|
|
|
TECHNETIUM THYROID(T
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
340T0001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$77.74 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$460.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.44
|
| Rate for Payer: Cash Price |
$299.00
|
| Rate for Payer: Cigna Commercial |
$496.34
|
| Rate for Payer: First Health Commercial |
$568.10
|
| Rate for Payer: Humana Commercial |
$508.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$490.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$441.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$179.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$526.24
|
| Rate for Payer: Ohio Health Group HMO |
$448.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$119.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$77.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$185.38
|
| Rate for Payer: PHCS Commercial |
$574.08
|
| Rate for Payer: United Healthcare All Payer |
$526.24
|
|
|
TEE ECHO CARIO
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
48000105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$2,256.00 |
| Rate for Payer: Aetna Commercial |
$524.04
|
| Rate for Payer: Anthem Medicaid |
$189.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,256.00
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Cigna Commercial |
$449.39
|
| Rate for Payer: Healthspan PPO |
$492.60
|
| Rate for Payer: Humana Medicaid |
$189.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.57
|
| Rate for Payer: Molina Healthcare Passport |
$189.77
|
| Rate for Payer: Multiplan PHCS |
$1,353.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,579.20
|
| Rate for Payer: UHCCP Medicaid |
$789.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.67
|
|
|
TEE ECHO CARIO
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
48000105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$2,165.76 |
| Rate for Payer: Aetna Commercial |
$1,737.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,759.68
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Cigna Commercial |
$1,872.48
|
| Rate for Payer: First Health Commercial |
$2,143.20
|
| Rate for Payer: Humana Commercial |
$1,917.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,849.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,664.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$676.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,985.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,692.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.36
|
| Rate for Payer: PHCS Commercial |
$2,165.76
|
| Rate for Payer: United Healthcare All Payer |
$1,985.28
|
|
|
TEE ECHO CARIO
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
48000105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$293.28 |
| Max. Negotiated Rate |
$2,165.76 |
| Rate for Payer: Aetna Commercial |
$1,737.12
|
| Rate for Payer: Anthem Medicaid |
$775.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,759.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Cigna Commercial |
$1,872.48
|
| Rate for Payer: First Health Commercial |
$2,143.20
|
| Rate for Payer: Humana Commercial |
$1,917.60
|
| Rate for Payer: Humana KY Medicaid |
$775.84
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$783.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,849.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,664.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$791.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,985.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,692.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$451.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$293.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$699.36
|
| Rate for Payer: PHCS Commercial |
$2,165.76
|
| Rate for Payer: United Healthcare All Payer |
$1,985.28
|
|
|
TEE ECHO CARIO (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
480P0105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$524.04 |
| Rate for Payer: Aetna Commercial |
$524.04
|
| Rate for Payer: Anthem Medicaid |
$189.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$449.39
|
| Rate for Payer: Healthspan PPO |
$492.60
|
| Rate for Payer: Humana Medicaid |
$189.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.57
|
| Rate for Payer: Molina Healthcare Passport |
$189.77
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.67
|
|
|
TEE ECHO CARIO (T
|
Facility
|
IP
|
$2,006.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
480T0105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$1,925.76 |
| Rate for Payer: Aetna Commercial |
$1,544.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,564.68
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cigna Commercial |
$1,664.98
|
| Rate for Payer: First Health Commercial |
$1,905.70
|
| Rate for Payer: Humana Commercial |
$1,705.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,644.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,480.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$601.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,765.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,504.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.86
|
| Rate for Payer: PHCS Commercial |
$1,925.76
|
| Rate for Payer: United Healthcare All Payer |
$1,765.28
|
|
|
TEE ECHO CARIO (T
|
Facility
|
OP
|
$2,006.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
480T0105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$260.78 |
| Max. Negotiated Rate |
$1,925.76 |
| Rate for Payer: Aetna Commercial |
$1,544.62
|
| Rate for Payer: Anthem Medicaid |
$689.86
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,564.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cash Price |
$1,003.00
|
| Rate for Payer: Cigna Commercial |
$1,664.98
|
| Rate for Payer: First Health Commercial |
$1,905.70
|
| Rate for Payer: Humana Commercial |
$1,705.10
|
| Rate for Payer: Humana KY Medicaid |
$689.86
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$696.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,644.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,480.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$703.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,765.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,504.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$401.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$260.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$621.86
|
| Rate for Payer: PHCS Commercial |
$1,925.76
|
| Rate for Payer: United Healthcare All Payer |
$1,765.28
|
|
|
TEE ECHO W/WO CONTRAST
|
Professional
|
Both
|
$3,530.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,235.50 |
| Max. Negotiated Rate |
$3,530.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$3,530.00
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Multiplan PHCS |
$2,118.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,471.00
|
| Rate for Payer: UHCCP Medicaid |
$1,235.50
|
|
|
TEE ECHO W/WO CONTRAST
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
TEE ECHO W/WO CONTRAST
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$458.90 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$458.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,094.30
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
TEE ECHO W/WO CONTRAST (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
483P0115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$524.04 |
| Rate for Payer: Aetna Commercial |
$524.04
|
| Rate for Payer: Anthem Medicaid |
$189.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$449.39
|
| Rate for Payer: Healthspan PPO |
$492.60
|
| Rate for Payer: Humana Medicaid |
$189.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$145.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.57
|
| Rate for Payer: Molina Healthcare Passport |
$189.77
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.67
|
|
|
TEE ECHO W/WO CONTRAST (T
|
Facility
|
OP
|
$3,280.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
483T0115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$3,148.80 |
| Rate for Payer: Aetna Commercial |
$2,525.60
|
| Rate for Payer: Anthem Medicaid |
$1,127.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$692.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$969.35
|
| Rate for Payer: CareSource Just4Me Medicare |
$934.73
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cigna Commercial |
$2,722.40
|
| Rate for Payer: First Health Commercial |
$3,116.00
|
| Rate for Payer: Humana Commercial |
$2,788.00
|
| Rate for Payer: Humana KY Medicaid |
$1,127.99
|
| Rate for Payer: Humana Medicare Advantage |
$692.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,139.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,689.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,420.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$830.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,150.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,016.80
|
| Rate for Payer: PHCS Commercial |
$3,148.80
|
| Rate for Payer: United Healthcare All Payer |
$2,886.40
|
|
|
TEE ECHO W/WO CONTRAST (T
|
Facility
|
IP
|
$3,280.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
483T0115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$3,148.80 |
| Rate for Payer: Aetna Commercial |
$2,525.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.40
|
| Rate for Payer: Cash Price |
$1,640.00
|
| Rate for Payer: Cigna Commercial |
$2,722.40
|
| Rate for Payer: First Health Commercial |
$3,116.00
|
| Rate for Payer: Humana Commercial |
$2,788.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,689.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,420.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,016.80
|
| Rate for Payer: PHCS Commercial |
$3,148.80
|
| Rate for Payer: United Healthcare All Payer |
$2,886.40
|
|
|
TEE READING REPORT
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 93314
|
| Hospital Charge Code |
48000094
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
TEE READING REPORT
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 93314
|
| Hospital Charge Code |
48000094
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$54.21 |
| Max. Negotiated Rate |
$400.32 |
| Rate for Payer: Aetna Commercial |
$321.09
|
| Rate for Payer: Anthem Medicaid |
$143.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$325.26
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$346.11
|
| Rate for Payer: First Health Commercial |
$396.15
|
| Rate for Payer: Humana Commercial |
$354.45
|
| Rate for Payer: Humana KY Medicaid |
$143.41
|
| Rate for Payer: Kentucky WC Medicaid |
$144.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$341.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$125.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$146.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$366.96
|
| Rate for Payer: Ohio Health Group HMO |
$312.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$83.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$54.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$129.27
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
TEE TAVR
|
Facility
|
OP
|
$1,859.00
|
|
|
Service Code
|
HCPCS 93355
|
| Hospital Charge Code |
48000036
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$241.67 |
| Max. Negotiated Rate |
$1,784.64 |
| Rate for Payer: Aetna Commercial |
$1,431.43
|
| Rate for Payer: Anthem Medicaid |
$639.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.02
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna Commercial |
$1,542.97
|
| Rate for Payer: First Health Commercial |
$1,766.05
|
| Rate for Payer: Humana Commercial |
$1,580.15
|
| Rate for Payer: Humana KY Medicaid |
$639.31
|
| Rate for Payer: Kentucky WC Medicaid |
$645.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,635.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,394.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.29
|
| Rate for Payer: PHCS Commercial |
$1,784.64
|
| Rate for Payer: United Healthcare All Payer |
$1,635.92
|
|
|
TEE TAVR
|
Facility
|
IP
|
$1,859.00
|
|
|
Service Code
|
HCPCS 93355
|
| Hospital Charge Code |
48000036
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$241.67 |
| Max. Negotiated Rate |
$1,784.64 |
| Rate for Payer: Aetna Commercial |
$1,431.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.02
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cigna Commercial |
$1,542.97
|
| Rate for Payer: First Health Commercial |
$1,766.05
|
| Rate for Payer: Humana Commercial |
$1,580.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,635.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,394.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.29
|
| Rate for Payer: PHCS Commercial |
$1,784.64
|
| Rate for Payer: United Healthcare All Payer |
$1,635.92
|
|
|
TEFLARO 10 MG (600MG VIAL)
|
Facility
|
OP
|
$661.52
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
25001955
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$635.06 |
| Rate for Payer: Aetna Commercial |
$509.37
|
| Rate for Payer: Anthem Medicaid |
$227.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$515.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.37
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.18
|
| Rate for Payer: Cash Price |
$330.76
|
| Rate for Payer: Cash Price |
$330.76
|
| Rate for Payer: Cigna Commercial |
$549.06
|
| Rate for Payer: First Health Commercial |
$628.44
|
| Rate for Payer: Humana Commercial |
$562.29
|
| Rate for Payer: Humana KY Medicaid |
$227.50
|
| Rate for Payer: Humana Medicare Advantage |
$3.84
|
| Rate for Payer: Kentucky WC Medicaid |
$229.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.14
|
| Rate for Payer: Ohio Health Group HMO |
$496.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.07
|
| Rate for Payer: PHCS Commercial |
$635.06
|
| Rate for Payer: United Healthcare All Payer |
$582.14
|
|
|
TEFLARO 10 MG (600MG VIAL)
|
Facility
|
IP
|
$661.52
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
25001955
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$635.06 |
| Rate for Payer: Aetna Commercial |
$509.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$515.99
|
| Rate for Payer: Cash Price |
$330.76
|
| Rate for Payer: Cigna Commercial |
$549.06
|
| Rate for Payer: First Health Commercial |
$628.44
|
| Rate for Payer: Humana Commercial |
$562.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.14
|
| Rate for Payer: Ohio Health Group HMO |
$496.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$132.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$86.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$205.07
|
| Rate for Payer: PHCS Commercial |
$635.06
|
| Rate for Payer: United Healthcare All Payer |
$582.14
|
|
|
TEGRETOL (CARBAM) 100MGTABCHEW
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 51672404101
|
| Hospital Charge Code |
25001495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem Medicaid |
$1.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Humana KY Medicaid |
$1.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
TEGRETOL (CARBAM) 100MGTABCHEW
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 51672404101
|
| Hospital Charge Code |
25001495
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.42 |
| Rate for Payer: Aetna Commercial |
$3.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.59
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna Commercial |
$3.82
|
| Rate for Payer: First Health Commercial |
$4.37
|
| Rate for Payer: Humana Commercial |
$3.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.05
|
| Rate for Payer: Ohio Health Group HMO |
$3.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.42
|
| Rate for Payer: United Healthcare All Payer |
$4.05
|
|
|
TEGRETOL (CARBAMAZE 200MG/1TAB
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 51672400501
|
| Hospital Charge Code |
25001496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
