|
CARDENE (NICARDIPINE 25MG/10ML
|
Facility
|
IP
|
$181.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25002925
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$54.46 |
| Max. Negotiated Rate |
$174.26 |
| Rate for Payer: Aetna Commercial |
$139.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$141.59
|
| Rate for Payer: Cash Price |
$90.76
|
| Rate for Payer: Cigna Commercial |
$150.66
|
| Rate for Payer: First Health Commercial |
$172.44
|
| Rate for Payer: Humana Commercial |
$154.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$148.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$133.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$159.74
|
| Rate for Payer: Ohio Health Group HMO |
$136.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$145.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$157.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$125.25
|
| Rate for Payer: PHCS Commercial |
$174.26
|
| Rate for Payer: United Healthcare All Payer |
$159.74
|
|
|
CARDIOASSIST EXTERNAL
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
HCPCS 92971
|
| Hospital Charge Code |
48000064
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$93.60 |
| 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 |
$249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.28
|
| Rate for Payer: PHCS Commercial |
$299.52
|
| Rate for Payer: United Healthcare All Payer |
$274.56
|
|
|
CARDIOASSIST EXTERNAL
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
HCPCS 92971
|
| Hospital Charge Code |
48000064
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$93.60 |
| 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 |
$249.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$215.28
|
| 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 |
$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
|
|
|
CARDIO ASSIST METHOD
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
HCPCS 92970
|
| Hospital Charge Code |
48000063
|
|
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
|
|
|
CARDIOMEMS INSERTION PROCEDURE
|
Facility
|
OP
|
$63,963.00
|
|
|
Service Code
|
HCPCS 33289
|
| Hospital Charge Code |
48100002
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$21,996.88 |
| 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 |
$26,267.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$49,891.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$36,774.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$35,460.73
|
| 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 |
$26,267.21
|
| 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 |
$31,520.65
|
| 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 |
$51,170.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55,647.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44,134.47
|
| 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 |
$19,188.90 |
| 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 |
$51,170.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$55,647.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$44,134.47
|
| 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
|
$111,200.00
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27000188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33,360.00 |
| Max. Negotiated Rate |
$106,752.00 |
| Rate for Payer: Aetna Commercial |
$85,624.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,736.00
|
| Rate for Payer: Cash Price |
$55,600.00
|
| Rate for Payer: Cigna Commercial |
$92,296.00
|
| Rate for Payer: First Health Commercial |
$105,640.00
|
| Rate for Payer: Humana Commercial |
$94,520.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,184.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,065.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,856.00
|
| Rate for Payer: Ohio Health Group HMO |
$83,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96,744.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76,728.00
|
| Rate for Payer: PHCS Commercial |
$106,752.00
|
| Rate for Payer: United Healthcare All Payer |
$97,856.00
|
|
|
CARDIO MEMS PA SENSOR SYSTEM
|
Facility
|
OP
|
$111,200.00
|
|
|
Service Code
|
HCPCS C2624
|
| Hospital Charge Code |
27000188
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$33,360.00 |
| Max. Negotiated Rate |
$106,752.00 |
| Rate for Payer: Aetna Commercial |
$85,624.00
|
| Rate for Payer: Anthem Medicaid |
$38,241.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$86,736.00
|
| Rate for Payer: Cash Price |
$55,600.00
|
| Rate for Payer: Cigna Commercial |
$92,296.00
|
| Rate for Payer: First Health Commercial |
$105,640.00
|
| Rate for Payer: Humana Commercial |
$94,520.00
|
| Rate for Payer: Humana KY Medicaid |
$38,241.68
|
| Rate for Payer: Kentucky WC Medicaid |
$38,630.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$91,184.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$82,065.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33,360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,008.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$97,856.00
|
| Rate for Payer: Ohio Health Group HMO |
$83,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88,960.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$96,744.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$76,728.00
|
| Rate for Payer: PHCS Commercial |
$106,752.00
|
| Rate for Payer: United Healthcare All Payer |
$97,856.00
|
|
|
Cardiovascular Stress Test
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 93016
|
| Hospital Charge Code |
51000182
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: Ambetter Exchange |
$19.60
|
| Rate for Payer: Anthem Medicaid |
$24.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$19.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$19.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$19.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.60
|
| 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 |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$24.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.60
|
|
|
CARDIOVASCULAR STRESS TEST
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 93016
|
| Hospital Charge Code |
48200012
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.58
|
| Rate for Payer: Ambetter Exchange |
$19.60
|
| Rate for Payer: Anthem Medicaid |
$24.39
|
| Rate for Payer: Buckeye Individual/Medicaid |
$19.60
|
| Rate for Payer: Buckeye Medicare Advantage |
$19.60
|
| Rate for Payer: CareSource Just4Me Medicare |
$23.52
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$19.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19.60
|
| 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 |
$25.48
|
| Rate for Payer: UHCCP Medicaid |
$24.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$24.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$19.60
|
|
|
CARDIOVERSION
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
48100057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$432.30 |
| Max. Negotiated Rate |
$1,383.36 |
| Rate for Payer: Aetna Commercial |
$1,109.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.98
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$1,196.03
|
| Rate for Payer: First Health Commercial |
$1,368.95
|
| Rate for Payer: Humana Commercial |
$1,224.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,181.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$432.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,268.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$994.29
|
| Rate for Payer: PHCS Commercial |
$1,383.36
|
| Rate for Payer: United Healthcare All Payer |
$1,268.08
|
|
|
CARDIOVERSION
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
48100057
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$495.56 |
| Max. Negotiated Rate |
$1,383.36 |
| Rate for Payer: Aetna Commercial |
$1,109.57
|
| Rate for Payer: Anthem Medicaid |
$495.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,123.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$846.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$816.25
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cigna Commercial |
$1,196.03
|
| Rate for Payer: First Health Commercial |
$1,368.95
|
| Rate for Payer: Humana Commercial |
$1,224.85
|
| Rate for Payer: Humana KY Medicaid |
$495.56
|
| Rate for Payer: Humana Medicare Advantage |
$604.63
|
| Rate for Payer: Kentucky WC Medicaid |
$500.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,181.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,063.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$505.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,268.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,080.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,152.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,253.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$994.29
|
| Rate for Payer: PHCS Commercial |
$1,383.36
|
| Rate for Payer: United Healthcare All Payer |
$1,268.08
|
|
|
CARDIOVERSION
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
76102467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$1,081.20 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Ambetter Exchange |
$100.98
|
| 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 Individual/Medicaid |
$100.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.18
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cash Price |
$901.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$122.75
|
| Rate for Payer: Molina Healthcare Passport |
$120.34
|
| Rate for Payer: Multiplan PHCS |
$1,081.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$131.27
|
| Rate for Payer: UHCCP Medicaid |
$58.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.98
|
|
|
CARDIOVERSION
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
76102467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$604.63 |
| Max. Negotiated Rate |
$1,729.92 |
| Rate for Payer: Aetna Commercial |
$1,387.54
|
| Rate for Payer: Anthem Medicaid |
$619.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$846.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$816.25
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cigna Commercial |
$1,495.66
|
| Rate for Payer: First Health Commercial |
$1,711.90
|
| Rate for Payer: Humana Commercial |
$1,531.70
|
| Rate for Payer: Humana KY Medicaid |
$619.71
|
| Rate for Payer: Humana Medicare Advantage |
$604.63
|
| Rate for Payer: Kentucky WC Medicaid |
$626.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.38
|
| Rate for Payer: PHCS Commercial |
$1,729.92
|
| Rate for Payer: United Healthcare All Payer |
$1,585.76
|
|
|
CARDIOVERSION
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
76102467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$540.60 |
| Max. Negotiated Rate |
$1,729.92 |
| Rate for Payer: Aetna Commercial |
$1,387.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.56
|
| Rate for Payer: Cash Price |
$901.00
|
| Rate for Payer: Cigna Commercial |
$1,495.66
|
| Rate for Payer: First Health Commercial |
$1,711.90
|
| Rate for Payer: Humana Commercial |
$1,531.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,477.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,329.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,585.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,567.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,243.38
|
| Rate for Payer: PHCS Commercial |
$1,729.92
|
| Rate for Payer: United Healthcare All Payer |
$1,585.76
|
|
|
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 |
$384.05 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Ambetter Exchange |
$100.98
|
| 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 Individual/Medicaid |
$100.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.98
|
| Rate for Payer: CareSource Just4Me Medicare |
$121.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$100.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$100.98
|
| 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 |
$131.27
|
| Rate for Payer: UHCCP Medicaid |
$58.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$121.54
|
| Rate for Payer: Wellcare Medicare Advantage |
$100.98
|
|
|
CARDIOVERSION(T
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
761T2467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$472.52 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem Medicaid |
$472.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$604.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$846.48
|
| Rate for Payer: CareSource Just4Me Medicare |
$816.25
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Humana KY Medicaid |
$472.52
|
| Rate for Payer: Humana Medicare Advantage |
$604.63
|
| Rate for Payer: Kentucky WC Medicaid |
$477.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$725.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$482.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
CARDIOVERSION(T
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
761T2467
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,319.04 |
| Rate for Payer: Aetna Commercial |
$1,057.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,071.72
|
| Rate for Payer: Cash Price |
$687.00
|
| Rate for Payer: Cigna Commercial |
$1,140.42
|
| Rate for Payer: First Health Commercial |
$1,305.30
|
| Rate for Payer: Humana Commercial |
$1,167.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,126.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,014.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$412.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,209.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,030.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,099.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,195.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$948.06
|
| Rate for Payer: PHCS Commercial |
$1,319.04
|
| Rate for Payer: United Healthcare All Payer |
$1,209.12
|
|
|
CARDIOVSC PHRM STRESS/ADENOSIN
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem Medicaid |
$427.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Humana KY Medicaid |
$427.12
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$431.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.98
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
CARDIOVSC PHRM STRESS/ADENOSIN
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200006
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.98
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
CARDIOVSC PHRM STRESS/LEXISCAN
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200007
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem Medicaid |
$427.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$287.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$402.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$388.44
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Humana KY Medicaid |
$427.12
|
| Rate for Payer: Humana Medicare Advantage |
$287.73
|
| Rate for Payer: Kentucky WC Medicaid |
$431.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.98
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
CARDIOVSC PHRM STRESS/LEXISCAN
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
HCPCS 93017
|
| Hospital Charge Code |
48200007
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$956.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$968.76
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,030.86
|
| Rate for Payer: First Health Commercial |
$1,179.90
|
| Rate for Payer: Humana Commercial |
$1,055.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,018.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$916.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.96
|
| Rate for Payer: Ohio Health Group HMO |
$931.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$993.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,080.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.98
|
| Rate for Payer: PHCS Commercial |
$1,192.32
|
| Rate for Payer: United Healthcare All Payer |
$1,092.96
|
|
|
CARDIZEM CD (DILTIA 120MG/1CAP
|
Facility
|
IP
|
$5.01
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
25000381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
|
CARDIZEM CD (DILTIA 120MG/1CAP
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 60687019501
|
| Hospital Charge Code |
25000381
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Aetna Commercial |
$3.86
|
| Rate for Payer: Anthem Medicaid |
$1.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.91
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cigna Commercial |
$4.16
|
| Rate for Payer: First Health Commercial |
$4.76
|
| Rate for Payer: Humana Commercial |
$4.26
|
| Rate for Payer: Humana KY Medicaid |
$1.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.41
|
| Rate for Payer: Ohio Health Group HMO |
$3.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.46
|
| Rate for Payer: PHCS Commercial |
$4.81
|
| Rate for Payer: United Healthcare All Payer |
$4.41
|
|
