|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$74,462.60
|
|
|
Service Code
|
MSDRG 217
|
| Min. Negotiated Rate |
$50,528.19 |
| Max. Negotiated Rate |
$74,462.60 |
| Rate for Payer: Anthem Medicaid |
$50,528.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$53,187.57
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74,462.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$71,803.22
|
| Rate for Payer: Humana KY Medicaid |
$50,528.19
|
| Rate for Payer: Humana Medicare Advantage |
$53,187.57
|
| Rate for Payer: Kentucky WC Medicaid |
$51,033.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63,825.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$51,538.76
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$113,534.60
|
|
|
Service Code
|
MSDRG 216
|
| Min. Negotiated Rate |
$77,041.33 |
| Max. Negotiated Rate |
$113,534.60 |
| Rate for Payer: Anthem Medicaid |
$77,041.33
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$81,096.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$113,534.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$109,479.79
|
| Rate for Payer: Humana KY Medicaid |
$77,041.33
|
| Rate for Payer: Humana Medicare Advantage |
$81,096.14
|
| Rate for Payer: Kentucky WC Medicaid |
$77,811.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$97,315.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$78,582.16
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$66,641.16
|
|
|
Service Code
|
MSDRG 218
|
| Min. Negotiated Rate |
$45,220.79 |
| Max. Negotiated Rate |
$66,641.16 |
| Rate for Payer: Anthem Medicaid |
$45,220.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$47,600.83
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$66,641.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$64,261.12
|
| Rate for Payer: Humana KY Medicaid |
$45,220.79
|
| Rate for Payer: Humana Medicare Advantage |
$47,600.83
|
| Rate for Payer: Kentucky WC Medicaid |
$45,673.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$57,121.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$46,125.20
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$61,352.40
|
|
|
Service Code
|
MSDRG 220
|
| Min. Negotiated Rate |
$41,631.98 |
| Max. Negotiated Rate |
$61,352.40 |
| Rate for Payer: Anthem Medicaid |
$41,631.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$43,823.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$61,352.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$59,161.24
|
| Rate for Payer: Humana KY Medicaid |
$41,631.98
|
| Rate for Payer: Humana Medicare Advantage |
$43,823.14
|
| Rate for Payer: Kentucky WC Medicaid |
$42,048.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$52,587.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$42,464.62
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$90,207.21
|
|
|
Service Code
|
MSDRG 219
|
| Min. Negotiated Rate |
$61,212.03 |
| Max. Negotiated Rate |
$90,207.21 |
| Rate for Payer: Anthem Medicaid |
$61,212.03
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$64,433.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$90,207.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$86,985.52
|
| Rate for Payer: Humana KY Medicaid |
$61,212.03
|
| Rate for Payer: Humana Medicare Advantage |
$64,433.72
|
| Rate for Payer: Kentucky WC Medicaid |
$61,824.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$77,320.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$62,436.27
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$54,380.28
|
|
|
Service Code
|
MSDRG 221
|
| Min. Negotiated Rate |
$36,900.91 |
| Max. Negotiated Rate |
$54,380.28 |
| Rate for Payer: Anthem Medicaid |
$36,900.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$38,843.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$54,380.28
|
| Rate for Payer: CareSource Just4Me Medicare |
$52,438.13
|
| Rate for Payer: Humana KY Medicaid |
$36,900.91
|
| Rate for Payer: Humana Medicare Advantage |
$38,843.06
|
| Rate for Payer: Kentucky WC Medicaid |
$37,269.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46,611.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,638.93
|
|
|
CARDIOASSIST EXTERNAL
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
HCPCS 92971
|
| Hospital Charge Code |
48000064
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$243.36
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$258.96
|
| Rate for Payer: First Health Commercial |
$296.40
|
| Rate for Payer: Humana Commercial |
$265.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.56
|
| Rate for Payer: Ohio Health Group HMO |
$234.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.72
|
| Rate for Payer: PHCS Commercial |
$299.52
|
| Rate for Payer: United Healthcare All Payer |
$274.56
|
|
|
CARDIOASSIST EXTERNAL
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
HCPCS 92971
|
| Hospital Charge Code |
48000064
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$40.56 |
| Max. Negotiated Rate |
$299.52 |
| Rate for Payer: Aetna Commercial |
$240.24
|
| Rate for Payer: Anthem Medicaid |
$107.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$243.36
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cigna Commercial |
$258.96
|
| Rate for Payer: First Health Commercial |
$296.40
|
| Rate for Payer: Humana Commercial |
$265.20
|
| Rate for Payer: Humana KY Medicaid |
$107.30
|
| Rate for Payer: Kentucky WC Medicaid |
$108.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$255.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$230.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$93.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$274.56
|
| Rate for Payer: Ohio Health Group HMO |
$234.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$62.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$40.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$96.72
|
| Rate for Payer: PHCS Commercial |
$299.52
|
| Rate for Payer: United Healthcare All Payer |
$274.56
|
|
|
CARDIO ASSIST METHOD
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
HCPCS 92970
|
| Hospital Charge Code |
48000063
|
|
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
|
|
|
CARDIO ASSIST METHOD
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 92970
|
| Hospital Charge Code |
48000063
|
|
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
|
|
|
CARDIOMEMS INSERTION PROCEDURE
|
Facility
|
OP
|
$63,963.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
48100002
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,315.19 |
| Max. Negotiated Rate |
$61,404.48 |
| Rate for Payer: Aetna Commercial |
$49,251.51
|
| Rate for Payer: Anthem Medicaid |
$21,996.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$25,133.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,891.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$35,187.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$33,930.48
|
| Rate for Payer: Cash Price |
$31,981.50
|
| Rate for Payer: Cash Price |
$31,981.50
|
| Rate for Payer: Cigna Commercial |
$53,089.29
|
| Rate for Payer: First Health Commercial |
$60,764.85
|
| Rate for Payer: Humana Commercial |
$54,368.55
|
| Rate for Payer: Humana KY Medicaid |
$21,996.88
|
| Rate for Payer: Humana Medicare Advantage |
$25,133.69
|
| Rate for Payer: Kentucky WC Medicaid |
$22,220.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,449.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,204.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$30,160.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,438.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,287.44
|
| Rate for Payer: Ohio Health Group HMO |
$47,972.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,792.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,315.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,828.53
|
| Rate for Payer: PHCS Commercial |
$61,404.48
|
| Rate for Payer: United Healthcare All Payer |
$56,287.44
|
|
|
CARDIOMEMS INSERTION PROCEDURE
|
Facility
|
IP
|
$63,963.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
48100002
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,315.19 |
| Max. Negotiated Rate |
$61,404.48 |
| Rate for Payer: Aetna Commercial |
$49,251.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,891.14
|
| Rate for Payer: Cash Price |
$31,981.50
|
| Rate for Payer: Cigna Commercial |
$53,089.29
|
| Rate for Payer: First Health Commercial |
$60,764.85
|
| Rate for Payer: Humana Commercial |
$54,368.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$52,449.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$47,204.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,188.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$56,287.44
|
| Rate for Payer: Ohio Health Group HMO |
$47,972.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,792.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,315.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,828.53
|
| Rate for Payer: PHCS Commercial |
$61,404.48
|
| Rate for Payer: United Healthcare All Payer |
$56,287.44
|
|
|
CARDIO MEMS PA SENSOR SYSTEM
|
Facility
|
IP
|
$106,900.00
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27000188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,897.00 |
| Max. Negotiated Rate |
$102,624.00 |
| Rate for Payer: Aetna Commercial |
$82,313.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,382.00
|
| Rate for Payer: Cash Price |
$53,450.00
|
| Rate for Payer: Cigna Commercial |
$88,727.00
|
| Rate for Payer: First Health Commercial |
$101,555.00
|
| Rate for Payer: Humana Commercial |
$90,865.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87,658.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,070.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,897.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,139.00
|
| Rate for Payer: PHCS Commercial |
$102,624.00
|
| Rate for Payer: United Healthcare All Payer |
$94,072.00
|
|
|
CARDIO MEMS PA SENSOR SYSTEM
|
Facility
|
OP
|
$106,900.00
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27000188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,897.00 |
| Max. Negotiated Rate |
$102,624.00 |
| Rate for Payer: Aetna Commercial |
$82,313.00
|
| Rate for Payer: Anthem Medicaid |
$36,762.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$83,382.00
|
| Rate for Payer: Cash Price |
$53,450.00
|
| Rate for Payer: Cigna Commercial |
$88,727.00
|
| Rate for Payer: First Health Commercial |
$101,555.00
|
| Rate for Payer: Humana Commercial |
$90,865.00
|
| Rate for Payer: Humana KY Medicaid |
$36,762.91
|
| Rate for Payer: Kentucky WC Medicaid |
$37,137.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$87,658.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$78,892.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$32,070.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$37,500.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$94,072.00
|
| Rate for Payer: Ohio Health Group HMO |
$80,175.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,897.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$33,139.00
|
| Rate for Payer: PHCS Commercial |
$102,624.00
|
| Rate for Payer: United Healthcare All Payer |
$94,072.00
|
|
|
Cardiovascular Stress Test
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 93016
|
| Hospital Charge Code |
51000182
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: Anthem Medicaid |
$24.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$36.76
|
| Rate for Payer: Healthspan PPO |
$38.14
|
| Rate for Payer: Humana Medicaid |
$24.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.88
|
| Rate for Payer: Molina Healthcare Passport |
$24.39
|
| Rate for Payer: Multiplan PHCS |
$41.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.30
|
| Rate for Payer: UHCCP Medicaid |
$24.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.63
|
|
|
CARDIOVASCULAR STRESS TEST
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 93016
|
| Hospital Charge Code |
48200012
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: Anthem Medicaid |
$24.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$69.00
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$36.76
|
| Rate for Payer: Healthspan PPO |
$38.14
|
| Rate for Payer: Humana Medicaid |
$24.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$24.88
|
| Rate for Payer: Molina Healthcare Passport |
$24.39
|
| Rate for Payer: Multiplan PHCS |
$41.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$48.30
|
| Rate for Payer: UHCCP Medicaid |
$24.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.63
|
|
|
CARDIOVERSION
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
48100057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$175.89 |
| Max. Negotiated Rate |
$1,298.88 |
| Rate for Payer: Aetna Commercial |
$1,041.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,055.34
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$1,122.99
|
| Rate for Payer: First Health Commercial |
$1,285.35
|
| Rate for Payer: Humana Commercial |
$1,150.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,109.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$998.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$405.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,190.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,014.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$419.43
|
| Rate for Payer: PHCS Commercial |
$1,298.88
|
| Rate for Payer: United Healthcare All Payer |
$1,190.64
|
|
|
CARDIOVERSION
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
48100057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$175.89 |
| Max. Negotiated Rate |
$1,298.88 |
| Rate for Payer: Aetna Commercial |
$1,041.81
|
| Rate for Payer: Anthem Medicaid |
$465.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$562.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,055.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$787.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.78
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$1,122.99
|
| Rate for Payer: First Health Commercial |
$1,285.35
|
| Rate for Payer: Humana Commercial |
$1,150.05
|
| Rate for Payer: Humana KY Medicaid |
$465.30
|
| Rate for Payer: Humana Medicare Advantage |
$562.80
|
| Rate for Payer: Kentucky WC Medicaid |
$470.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,109.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$998.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$474.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,190.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,014.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$270.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$175.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$419.43
|
| Rate for Payer: PHCS Commercial |
$1,298.88
|
| Rate for Payer: United Healthcare All Payer |
$1,190.64
|
|
|
CARDIOVERSION
|
Professional
|
Both
|
$1,718.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
76102467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$1,718.00 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.81
|
| Rate for Payer: Anthem Medicaid |
$120.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,718.00
|
| Rate for Payer: Cash Price |
$859.00
|
| Rate for Payer: Cash Price |
$859.00
|
| Rate for Payer: Cigna Commercial |
$200.51
|
| Rate for Payer: Healthspan PPO |
$384.05
|
| Rate for Payer: Humana Medicaid |
$120.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.75
|
| Rate for Payer: Molina Healthcare Passport |
$120.34
|
| Rate for Payer: Multiplan PHCS |
$1,030.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,202.60
|
| Rate for Payer: UHCCP Medicaid |
$58.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.54
|
|
|
CARDIOVERSION
|
Facility
|
OP
|
$1,718.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
76102467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,649.28 |
| Rate for Payer: Aetna Commercial |
$1,322.86
|
| Rate for Payer: Anthem Medicaid |
$590.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$562.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,340.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$787.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.78
|
| Rate for Payer: Cash Price |
$859.00
|
| Rate for Payer: Cash Price |
$859.00
|
| Rate for Payer: Cigna Commercial |
$1,425.94
|
| Rate for Payer: First Health Commercial |
$1,632.10
|
| Rate for Payer: Humana Commercial |
$1,460.30
|
| Rate for Payer: Humana KY Medicaid |
$590.82
|
| Rate for Payer: Humana Medicare Advantage |
$562.80
|
| Rate for Payer: Kentucky WC Medicaid |
$596.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.58
|
| Rate for Payer: PHCS Commercial |
$1,649.28
|
| Rate for Payer: United Healthcare All Payer |
$1,511.84
|
|
|
CARDIOVERSION
|
Facility
|
IP
|
$1,718.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
76102467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,649.28 |
| Rate for Payer: Aetna Commercial |
$1,322.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,340.04
|
| Rate for Payer: Cash Price |
$859.00
|
| Rate for Payer: Cigna Commercial |
$1,425.94
|
| Rate for Payer: First Health Commercial |
$1,632.10
|
| Rate for Payer: Humana Commercial |
$1,460.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.58
|
| Rate for Payer: PHCS Commercial |
$1,649.28
|
| Rate for Payer: United Healthcare All Payer |
$1,511.84
|
|
|
CARDIOVERSION(P
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
761P2467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$55.81
|
| Rate for Payer: Anthem Medicaid |
$120.34
|
| Rate for Payer: Buckeye Medicare Advantage |
$428.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cash Price |
$214.00
|
| Rate for Payer: Cigna Commercial |
$200.51
|
| Rate for Payer: Healthspan PPO |
$384.05
|
| Rate for Payer: Humana Medicaid |
$120.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$170.62
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.75
|
| Rate for Payer: Molina Healthcare Passport |
$120.34
|
| Rate for Payer: Multiplan PHCS |
$256.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$299.60
|
| Rate for Payer: UHCCP Medicaid |
$58.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.54
|
|
|
CARDIOVERSION(T
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
761T2467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$387.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
CARDIOVERSION(T
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
761T2467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$167.70 |
| Max. Negotiated Rate |
$1,238.40 |
| Rate for Payer: Aetna Commercial |
$993.30
|
| Rate for Payer: Anthem Medicaid |
$443.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$562.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,006.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$787.92
|
| Rate for Payer: CareSource Just4Me Medicare |
$759.78
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cash Price |
$645.00
|
| Rate for Payer: Cigna Commercial |
$1,070.70
|
| Rate for Payer: First Health Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial |
$1,096.50
|
| Rate for Payer: Humana KY Medicaid |
$443.63
|
| Rate for Payer: Humana Medicare Advantage |
$562.80
|
| Rate for Payer: Kentucky WC Medicaid |
$448.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,057.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$952.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$675.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,135.20
|
| Rate for Payer: Ohio Health Group HMO |
$967.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$258.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$399.90
|
| Rate for Payer: PHCS Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Payer |
$1,135.20
|
|
|
CARDIOVSC PHRM STRESS/ADENOSIN
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$1,119.36 |
| Rate for Payer: Aetna Commercial |
$897.82
|
| Rate for Payer: Anthem Medicaid |
$400.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$271.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$380.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$366.43
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cash Price |
$583.00
|
| Rate for Payer: Cigna Commercial |
$967.78
|
| Rate for Payer: First Health Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial |
$991.10
|
| Rate for Payer: Humana KY Medicaid |
$400.99
|
| Rate for Payer: Humana Medicare Advantage |
$271.43
|
| Rate for Payer: Kentucky WC Medicaid |
$405.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.08
|
| Rate for Payer: Ohio Health Group HMO |
$874.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.46
|
| Rate for Payer: PHCS Commercial |
$1,119.36
|
| Rate for Payer: United Healthcare All Payer |
$1,026.08
|
|
