|
TECHNETIUM TC99M DISOFENIN
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
HCPCS A9510
|
| Hospital Charge Code |
34000051
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem Medicaid |
$78.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.62
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Humana KY Medicaid |
$78.75
|
| Rate for Payer: Kentucky WC Medicaid |
$79.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$80.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
TECHNETIUM TC99M DISOFENIN
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
HCPCS A9510
|
| Hospital Charge Code |
34000051
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$219.84 |
| Rate for Payer: Aetna Commercial |
$176.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$178.62
|
| Rate for Payer: Cash Price |
$114.50
|
| Rate for Payer: Cigna Commercial |
$190.07
|
| Rate for Payer: First Health Commercial |
$217.55
|
| Rate for Payer: Humana Commercial |
$194.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$187.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$169.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$68.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$201.52
|
| Rate for Payer: Ohio Health Group HMO |
$171.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$183.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$158.01
|
| Rate for Payer: PHCS Commercial |
$219.84
|
| Rate for Payer: United Healthcare All Payer |
$201.52
|
|
|
TECHNETIUM THYROID
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$224.40 |
| 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 |
$598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$516.12
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
TECHNETIUM THYROID
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$257.24 |
| Max. Negotiated Rate |
$718.08 |
| Rate for Payer: Aetna Commercial |
$575.96
|
| Rate for Payer: Anthem Medicaid |
$257.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$583.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| Rate for Payer: Cash Price |
$374.00
|
| 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: Humana KY Medicaid |
$257.24
|
| Rate for Payer: Humana Medicare Advantage |
$371.28
|
| Rate for Payer: Kentucky WC Medicaid |
$259.86
|
| 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 |
$445.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$262.40
|
| 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 |
$598.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$516.12
|
| Rate for Payer: PHCS Commercial |
$718.08
|
| Rate for Payer: United Healthcare All Payer |
$658.24
|
|
|
TECHNETIUM THYROID
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
34000001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$448.80 |
| Rate for Payer: Ambetter Exchange |
$150.11
|
| Rate for Payer: Anthem Medicaid |
$160.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.13
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$150.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$164.14
|
| Rate for Payer: Molina Healthcare Passport |
$160.92
|
| Rate for Payer: Multiplan PHCS |
$448.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$195.14
|
| Rate for Payer: UHCCP Medicaid |
$261.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.11
|
|
|
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: Ambetter Exchange |
$150.11
|
| Rate for Payer: Anthem Medicaid |
$160.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$150.11
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.11
|
| Rate for Payer: CareSource Just4Me Medicare |
$180.13
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$150.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$150.11
|
| 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 |
$195.14
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$162.53
|
| Rate for Payer: Wellcare Medicare Advantage |
$150.11
|
|
|
TECHNETIUM THYROID(T
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS 78013
|
| Hospital Charge Code |
340T0001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$205.65 |
| 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 |
$371.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$466.44
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$519.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$501.23
|
| 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 |
$371.28
|
| 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 |
$445.54
|
| 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 |
$478.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.62
|
| 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 |
$179.40 |
| 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 |
$478.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.62
|
| Rate for Payer: PHCS Commercial |
$574.08
|
| Rate for Payer: United Healthcare All Payer |
$526.24
|
|
|
TEE ECHO CARIO
|
Facility
|
OP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
48000105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,297.28 |
| Rate for Payer: Aetna Commercial |
$1,842.61
|
| Rate for Payer: Anthem Medicaid |
$822.95
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,196.50
|
| Rate for Payer: Cash Price |
$1,196.50
|
| Rate for Payer: Cigna Commercial |
$1,986.19
|
| Rate for Payer: First Health Commercial |
$2,273.35
|
| Rate for Payer: Humana Commercial |
$2,034.05
|
| Rate for Payer: Humana KY Medicaid |
$822.95
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$831.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,962.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,766.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$839.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.17
|
| Rate for Payer: PHCS Commercial |
$2,297.28
|
| Rate for Payer: United Healthcare All Payer |
$2,105.84
|
|
|
TEE ECHO CARIO
|
Facility
|
IP
|
$2,393.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
48000105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$717.90 |
| Max. Negotiated Rate |
$2,297.28 |
| Rate for Payer: Aetna Commercial |
$1,842.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,866.54
|
| Rate for Payer: Cash Price |
$1,196.50
|
| Rate for Payer: Cigna Commercial |
$1,986.19
|
| Rate for Payer: First Health Commercial |
$2,273.35
|
| Rate for Payer: Humana Commercial |
$2,034.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,962.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,766.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$717.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,105.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,794.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,914.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,081.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.17
|
| Rate for Payer: PHCS Commercial |
$2,297.28
|
| Rate for Payer: United Healthcare All Payer |
$2,105.84
|
|
|
TEE ECHO CARIO
|
Professional
|
Both
|
$2,393.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
48000105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$1,435.80 |
| Rate for Payer: Aetna Commercial |
$524.04
|
| Rate for Payer: Ambetter Exchange |
$212.41
|
| Rate for Payer: Anthem Medicaid |
$189.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$212.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.89
|
| Rate for Payer: Cash Price |
$1,196.50
|
| Rate for Payer: Cash Price |
$1,196.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$212.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.41
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$193.57
|
| Rate for Payer: Molina Healthcare Passport |
$189.77
|
| Rate for Payer: Multiplan PHCS |
$1,435.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$276.13
|
| Rate for Payer: UHCCP Medicaid |
$837.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.41
|
|
|
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: Ambetter Exchange |
$212.41
|
| Rate for Payer: Anthem Medicaid |
$189.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$212.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$212.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.41
|
| 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 |
$276.13
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.41
|
|
|
TEE ECHO CARIO (T
|
Facility
|
IP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
480T0105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$640.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
TEE ECHO CARIO (T
|
Facility
|
OP
|
$2,136.00
|
|
|
Service Code
|
HCPCS 93312
|
| Hospital Charge Code |
480T0105
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$2,050.56 |
| Rate for Payer: Aetna Commercial |
$1,644.72
|
| Rate for Payer: Anthem Medicaid |
$734.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,666.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cigna Commercial |
$1,772.88
|
| Rate for Payer: First Health Commercial |
$2,029.20
|
| Rate for Payer: Humana Commercial |
$1,815.60
|
| Rate for Payer: Humana KY Medicaid |
$734.57
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$742.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,751.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,576.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,879.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,602.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,708.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,858.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,473.84
|
| Rate for Payer: PHCS Commercial |
$2,050.56
|
| Rate for Payer: United Healthcare All Payer |
$1,879.68
|
|
|
TEE ECHO W/WO CONTRAST
|
Facility
|
OP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,480.00 |
| Rate for Payer: Aetna Commercial |
$2,791.25
|
| Rate for Payer: Anthem Medicaid |
$1,246.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,827.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,812.50
|
| Rate for Payer: Cash Price |
$1,812.50
|
| Rate for Payer: Cigna Commercial |
$3,008.75
|
| Rate for Payer: First Health Commercial |
$3,443.75
|
| Rate for Payer: Humana Commercial |
$3,081.25
|
| Rate for Payer: Humana KY Medicaid |
$1,246.64
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,259.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,972.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,675.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,271.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,190.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,501.25
|
| Rate for Payer: PHCS Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare All Payer |
$3,190.00
|
|
|
TEE ECHO W/WO CONTRAST
|
Facility
|
IP
|
$3,625.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,087.50 |
| Max. Negotiated Rate |
$3,480.00 |
| Rate for Payer: Aetna Commercial |
$2,791.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,827.50
|
| Rate for Payer: Cash Price |
$1,812.50
|
| Rate for Payer: Cigna Commercial |
$3,008.75
|
| Rate for Payer: First Health Commercial |
$3,443.75
|
| Rate for Payer: Humana Commercial |
$3,081.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,972.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,675.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,087.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,190.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,501.25
|
| Rate for Payer: PHCS Commercial |
$3,480.00
|
| Rate for Payer: United Healthcare All Payer |
$3,190.00
|
|
|
TEE ECHO W/WO CONTRAST
|
Professional
|
Both
|
$3,625.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
48300115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,268.75 |
| Max. Negotiated Rate |
$2,537.50 |
| Rate for Payer: Cash Price |
$1,812.50
|
| Rate for Payer: Multiplan PHCS |
$2,175.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,537.50
|
| Rate for Payer: UHCCP Medicaid |
$1,268.75
|
|
|
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: Ambetter Exchange |
$212.41
|
| Rate for Payer: Anthem Medicaid |
$189.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$212.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$212.41
|
| Rate for Payer: CareSource Just4Me Medicare |
$254.89
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$212.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$212.41
|
| 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 |
$276.13
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$191.67
|
| Rate for Payer: Wellcare Medicare Advantage |
$212.41
|
|
|
TEE ECHO W/WO CONTRAST (T
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
483T0115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna Commercial |
$2,598.75
|
| Rate for Payer: Anthem Medicaid |
$1,160.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$730.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,632.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,022.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$985.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$2,801.25
|
| Rate for Payer: First Health Commercial |
$3,206.25
|
| Rate for Payer: Humana Commercial |
$2,868.75
|
| Rate for Payer: Humana KY Medicaid |
$1,160.66
|
| Rate for Payer: Humana Medicare Advantage |
$730.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,172.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,767.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,490.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,970.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,328.75
|
| Rate for Payer: PHCS Commercial |
$3,240.00
|
| Rate for Payer: United Healthcare All Payer |
$2,970.00
|
|
|
TEE ECHO W/WO CONTRAST (T
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
HCPCS C8925
|
| Hospital Charge Code |
483T0115
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,012.50 |
| Max. Negotiated Rate |
$3,240.00 |
| Rate for Payer: Aetna Commercial |
$2,598.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,632.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$2,801.25
|
| Rate for Payer: First Health Commercial |
$3,206.25
|
| Rate for Payer: Humana Commercial |
$2,868.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,767.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,490.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,970.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,531.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,936.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,328.75
|
| Rate for Payer: PHCS Commercial |
$3,240.00
|
| Rate for Payer: United Healthcare All Payer |
$2,970.00
|
|
|
TEE READING REPORT
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 93314
|
| Hospital Charge Code |
48000094
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$125.10 |
| 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 |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| 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 |
$125.10 |
| 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 |
$333.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$362.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$287.73
|
| Rate for Payer: PHCS Commercial |
$400.32
|
| Rate for Payer: United Healthcare All Payer |
$366.96
|
|
|
TEE TAVR
|
Facility
|
IP
|
$1,859.00
|
|
|
Service Code
|
HCPCS 93355
|
| Hospital Charge Code |
48000036
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$557.70 |
| 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 |
$1,487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,617.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.71
|
| Rate for Payer: PHCS Commercial |
$1,784.64
|
| Rate for Payer: United Healthcare All Payer |
$1,635.92
|
|
|
TEE TAVR
|
Facility
|
OP
|
$1,859.00
|
|
|
Service Code
|
HCPCS 93355
|
| Hospital Charge Code |
48000036
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$557.70 |
| 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 |
$1,487.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,617.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,282.71
|
| 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 |
$4.24 |
| 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 |
$4.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$515.99
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$5.94
|
| Rate for Payer: CareSource Just4Me Medicare |
$5.72
|
| 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 |
$4.24
|
| 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 |
$5.09
|
| 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 |
$529.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.45
|
| Rate for Payer: PHCS Commercial |
$635.06
|
| Rate for Payer: United Healthcare All Payer |
$582.14
|
|
