|
CARD MRI VELOC FLOW MAPPING
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem Medicaid |
$307.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Humana KY Medicaid |
$307.45
|
| Rate for Payer: Kentucky WC Medicaid |
$310.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.14
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
CARD MRI VELOC FLOW MAPPING
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$178.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$116.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$277.14
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
CARD MRI VELOC FLOW MAPPING
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
61000046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$894.00 |
| Rate for Payer: Aetna Commercial |
$137.32
|
| Rate for Payer: Anthem Medicaid |
$65.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$894.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$141.05
|
| Rate for Payer: Healthspan PPO |
$74.24
|
| Rate for Payer: Humana Medicaid |
$65.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.81
|
| Rate for Payer: Molina Healthcare Passport |
$65.50
|
| Rate for Payer: Multiplan PHCS |
$536.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$625.80
|
| Rate for Payer: UHCCP Medicaid |
$312.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.16
|
|
|
CARD MRI VELOC FLOW MAPPING(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
610P0046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Aetna Commercial |
$137.32
|
| Rate for Payer: Anthem Medicaid |
$65.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$141.05
|
| Rate for Payer: Healthspan PPO |
$74.24
|
| Rate for Payer: Humana Medicaid |
$65.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$15.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$66.81
|
| Rate for Payer: Molina Healthcare Passport |
$65.50
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$66.16
|
|
|
CARD MRI VELOC FLOW MAPPING(T
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
610T0046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$819.84 |
| Rate for Payer: Aetna Commercial |
$657.58
|
| Rate for Payer: Anthem Medicaid |
$293.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$666.12
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$708.82
|
| Rate for Payer: First Health Commercial |
$811.30
|
| Rate for Payer: Humana Commercial |
$725.90
|
| Rate for Payer: Humana KY Medicaid |
$293.69
|
| Rate for Payer: Kentucky WC Medicaid |
$296.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$700.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$630.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$299.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$751.52
|
| Rate for Payer: Ohio Health Group HMO |
$640.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.74
|
| Rate for Payer: PHCS Commercial |
$819.84
|
| Rate for Payer: United Healthcare All Payer |
$751.52
|
|
|
CARD MRI VELOC FLOW MAPPING(T
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
610T0046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$819.84 |
| Rate for Payer: Aetna Commercial |
$657.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$666.12
|
| Rate for Payer: Cash Price |
$427.00
|
| Rate for Payer: Cigna Commercial |
$708.82
|
| Rate for Payer: First Health Commercial |
$811.30
|
| Rate for Payer: Humana Commercial |
$725.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$700.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$630.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$256.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$751.52
|
| Rate for Payer: Ohio Health Group HMO |
$640.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$170.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$111.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$264.74
|
| Rate for Payer: PHCS Commercial |
$819.84
|
| Rate for Payer: United Healthcare All Payer |
$751.52
|
|
|
CARD REHAB W/ECG MON PH II >36
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300004
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
CARD REHAB W/ECG MON PH II >36
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300004
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem Medicaid |
$98.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$159.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.26
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Humana KY Medicaid |
$98.36
|
| Rate for Payer: Humana Medicare Advantage |
$114.27
|
| Rate for Payer: Kentucky WC Medicaid |
$99.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
CARD REHAB W/ECG MO PH II
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$85.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
CARD REHAB W/ECG MO PH II
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$37.18 |
| Max. Negotiated Rate |
$274.56 |
| Rate for Payer: Aetna Commercial |
$220.22
|
| Rate for Payer: Anthem Medicaid |
$98.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$223.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$159.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.26
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cigna Commercial |
$237.38
|
| Rate for Payer: First Health Commercial |
$271.70
|
| Rate for Payer: Humana Commercial |
$243.10
|
| Rate for Payer: Humana KY Medicaid |
$98.36
|
| Rate for Payer: Humana Medicare Advantage |
$114.27
|
| Rate for Payer: Kentucky WC Medicaid |
$99.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$234.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$211.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$251.68
|
| Rate for Payer: Ohio Health Group HMO |
$214.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$57.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$88.66
|
| Rate for Payer: PHCS Commercial |
$274.56
|
| Rate for Payer: United Healthcare All Payer |
$251.68
|
|
|
CARD REHAB W/O ECG MON>36 SESS
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300003
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem Medicaid |
$96.29
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$114.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$159.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$154.26
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Humana KY Medicaid |
$96.29
|
| Rate for Payer: Humana Medicare Advantage |
$114.27
|
| Rate for Payer: Kentucky WC Medicaid |
$97.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.80
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
CARD REHAB W/O ECG MON>36 SESS
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300003
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: Aetna Commercial |
$215.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$218.40
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$232.40
|
| Rate for Payer: First Health Commercial |
$266.00
|
| Rate for Payer: Humana Commercial |
$238.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$229.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$206.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$84.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$246.40
|
| Rate for Payer: Ohio Health Group HMO |
$210.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$56.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.80
|
| Rate for Payer: PHCS Commercial |
$268.80
|
| Rate for Payer: United Healthcare All Payer |
$246.40
|
|
|
CARDURA (DOXAZOSIN) 1 1MG/1TAB
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 60505009300
|
| Hospital Charge Code |
25000387
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.84
|
| Rate for Payer: First Health Commercial |
$4.40
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
CARDURA (DOXAZOSIN) 1 1MG/1TAB
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 60505009300
|
| Hospital Charge Code |
25000387
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$3.57
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.61
|
| Rate for Payer: Cash Price |
$2.32
|
| Rate for Payer: Cigna Commercial |
$3.84
|
| Rate for Payer: First Health Commercial |
$4.40
|
| Rate for Payer: Humana Commercial |
$3.94
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.07
|
| Rate for Payer: Ohio Health Group HMO |
$3.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.44
|
| Rate for Payer: PHCS Commercial |
$4.44
|
| Rate for Payer: United Healthcare All Payer |
$4.07
|
|
|
CARDURA (DOXAZOSIN) 2 2MG/1TAB
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 50268022315
|
| Hospital Charge Code |
25000388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem Medicaid |
$1.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Humana KY Medicaid |
$1.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
CARDURA (DOXAZOSIN) 2 2MG/1TAB
|
Facility
|
IP
|
$4.90
|
|
|
Service Code
|
NDC 50268022315
|
| Hospital Charge Code |
25000388
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.82
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Cigna Commercial |
$4.07
|
| Rate for Payer: First Health Commercial |
$4.66
|
| Rate for Payer: Humana Commercial |
$4.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.31
|
| Rate for Payer: Ohio Health Group HMO |
$3.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.52
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
CARD VASC PHAR STRES ECHO
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000035
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$1,470.72 |
| Rate for Payer: Aetna Commercial |
$1,179.64
|
| Rate for Payer: Anthem Medicaid |
$526.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cigna Commercial |
$1,271.56
|
| Rate for Payer: First Health Commercial |
$1,455.40
|
| Rate for Payer: Humana Commercial |
$1,302.20
|
| Rate for Payer: Humana KY Medicaid |
$526.85
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$532.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$537.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.92
|
| Rate for Payer: PHCS Commercial |
$1,470.72
|
| Rate for Payer: United Healthcare All Payer |
$1,348.16
|
|
|
CARD VASC PHAR STRES ECHO
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000035
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$1,470.72 |
| Rate for Payer: Aetna Commercial |
$1,179.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.96
|
| Rate for Payer: Cash Price |
$766.00
|
| Rate for Payer: Cigna Commercial |
$1,271.56
|
| Rate for Payer: First Health Commercial |
$1,455.40
|
| Rate for Payer: Humana Commercial |
$1,302.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,256.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,130.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,348.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,149.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.92
|
| Rate for Payer: PHCS Commercial |
$1,470.72
|
| Rate for Payer: United Healthcare All Payer |
$1,348.16
|
|
|
CARDVASC STRESS ECHO
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
CARDVASC STRESS ECHO
|
Professional
|
Both
|
$1,924.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$1,924.00 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: Anthem Medicaid |
$126.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,924.00
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$266.92
|
| Rate for Payer: Healthspan PPO |
$319.29
|
| Rate for Payer: Humana Medicaid |
$126.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.60
|
| Rate for Payer: Molina Healthcare Passport |
$126.08
|
| Rate for Payer: Multiplan PHCS |
$1,154.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,346.80
|
| Rate for Payer: UHCCP Medicaid |
$673.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.34
|
|
|
CARDVASC STRESS ECHO
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem Medicaid |
$661.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Humana KY Medicaid |
$661.66
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$668.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
CARDVASC STRESS ECHO(P
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
480P0106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: Anthem Medicaid |
$126.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$270.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$266.92
|
| Rate for Payer: Healthspan PPO |
$319.29
|
| Rate for Payer: Humana Medicaid |
$126.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$100.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.60
|
| Rate for Payer: Molina Healthcare Passport |
$126.08
|
| Rate for Payer: Multiplan PHCS |
$162.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$189.00
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.34
|
|
|
CARDVASC STRESS ECHO(T
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
480T0106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$215.02 |
| Max. Negotiated Rate |
$1,587.84 |
| Rate for Payer: Aetna Commercial |
$1,273.58
|
| Rate for Payer: Anthem Medicaid |
$568.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$477.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$667.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$644.03
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$1,372.82
|
| Rate for Payer: First Health Commercial |
$1,571.30
|
| Rate for Payer: Humana Commercial |
$1,405.90
|
| Rate for Payer: Humana KY Medicaid |
$568.81
|
| Rate for Payer: Humana Medicare Advantage |
$477.06
|
| Rate for Payer: Kentucky WC Medicaid |
$574.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,356.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,220.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$580.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,455.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,240.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$512.74
|
| Rate for Payer: PHCS Commercial |
$1,587.84
|
| Rate for Payer: United Healthcare All Payer |
$1,455.52
|
|
|
CARDVASC STRESS ECHO(T
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
480T0106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$215.02 |
| Max. Negotiated Rate |
$1,587.84 |
| Rate for Payer: Aetna Commercial |
$1,273.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,290.12
|
| Rate for Payer: Cash Price |
$827.00
|
| Rate for Payer: Cigna Commercial |
$1,372.82
|
| Rate for Payer: First Health Commercial |
$1,571.30
|
| Rate for Payer: Humana Commercial |
$1,405.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,356.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,220.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$496.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,455.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,240.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$330.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$215.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$512.74
|
| Rate for Payer: PHCS Commercial |
$1,587.84
|
| Rate for Payer: United Healthcare All Payer |
$1,455.52
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$13.00
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$6.23
|
| Rate for Payer: Humana Medicaid |
$3.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$5.54
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.45
|
| Rate for Payer: Molina Healthcare Passport |
$3.38
|
| Rate for Payer: Multiplan PHCS |
$7.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9.10
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
|
