|
CARD MRI VELOC FLOW MAPPING(T
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS 75565
|
| Hospital Charge Code |
610T0046
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$273.00 |
| Max. Negotiated Rate |
$873.60 |
| Rate for Payer: Aetna Commercial |
$700.70
|
| Rate for Payer: Anthem Medicaid |
$312.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$709.80
|
| Rate for Payer: Cash Price |
$455.00
|
| Rate for Payer: Cigna Commercial |
$755.30
|
| Rate for Payer: First Health Commercial |
$864.50
|
| Rate for Payer: Humana Commercial |
$773.50
|
| Rate for Payer: Humana KY Medicaid |
$312.95
|
| Rate for Payer: Kentucky WC Medicaid |
$316.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$746.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$671.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$273.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$319.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$800.80
|
| Rate for Payer: Ohio Health Group HMO |
$682.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$791.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.90
|
| Rate for Payer: PHCS Commercial |
$873.60
|
| Rate for Payer: United Healthcare All Payer |
$800.80
|
|
|
CARD REHAB W/ECG MON PH II >36
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300004
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$88.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$235.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.86
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
CARD REHAB W/ECG MON PH II >36
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300004
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$101.11 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Aetna Commercial |
$226.38
|
| Rate for Payer: Anthem Medicaid |
$101.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$116.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$229.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$162.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.06
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$244.02
|
| Rate for Payer: First Health Commercial |
$279.30
|
| Rate for Payer: Humana Commercial |
$249.90
|
| Rate for Payer: Humana KY Medicaid |
$101.11
|
| Rate for Payer: Humana Medicare Advantage |
$116.34
|
| Rate for Payer: Kentucky WC Medicaid |
$102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$241.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$216.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$103.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$258.72
|
| Rate for Payer: Ohio Health Group HMO |
$220.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$235.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$202.86
|
| Rate for Payer: PHCS Commercial |
$282.24
|
| Rate for Payer: United Healthcare All Payer |
$258.72
|
|
|
CARD REHAB W/ECG MO PH II
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem Medicaid |
$104.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$116.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$162.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.06
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Humana KY Medicaid |
$104.55
|
| Rate for Payer: Humana Medicare Advantage |
$116.34
|
| Rate for Payer: Kentucky WC Medicaid |
$105.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$106.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
CARD REHAB W/ECG MO PH II
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
HCPCS 93798
|
| Hospital Charge Code |
94300002
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$291.84 |
| Rate for Payer: Aetna Commercial |
$234.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$237.12
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cigna Commercial |
$252.32
|
| Rate for Payer: First Health Commercial |
$288.80
|
| Rate for Payer: Humana Commercial |
$258.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$249.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$224.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$267.52
|
| Rate for Payer: Ohio Health Group HMO |
$228.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$243.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$209.76
|
| Rate for Payer: PHCS Commercial |
$291.84
|
| Rate for Payer: United Healthcare All Payer |
$267.52
|
|
|
CARD REHAB W/O ECG MON>36 SESS
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300003
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$86.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
CARD REHAB W/O ECG MON>36 SESS
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
HCPCS 93797
|
| Hospital Charge Code |
94300003
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$99.04 |
| Max. Negotiated Rate |
$276.48 |
| Rate for Payer: Aetna Commercial |
$221.76
|
| Rate for Payer: Anthem Medicaid |
$99.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$116.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$224.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$162.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.06
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$239.04
|
| Rate for Payer: First Health Commercial |
$273.60
|
| Rate for Payer: Humana Commercial |
$244.80
|
| Rate for Payer: Humana KY Medicaid |
$99.04
|
| Rate for Payer: Humana Medicare Advantage |
$116.34
|
| Rate for Payer: Kentucky WC Medicaid |
$100.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$236.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$212.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$139.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$101.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$253.44
|
| Rate for Payer: Ohio Health Group HMO |
$216.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$198.72
|
| Rate for Payer: PHCS Commercial |
$276.48
|
| Rate for Payer: United Healthcare All Payer |
$253.44
|
|
|
CARDURA (DOXAZOSIN) 1 1MG/1TAB
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 60505009300
|
| Hospital Charge Code |
25000387
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| 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 |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| 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 |
$1.39 |
| 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 |
$3.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.19
|
| 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 |
$1.47 |
| 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 |
$4.17
|
| 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 |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| 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 |
$1.47 |
| 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 |
$4.17
|
| 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 |
$3.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.38
|
| Rate for Payer: PHCS Commercial |
$4.70
|
| Rate for Payer: United Healthcare All Payer |
$4.31
|
|
|
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 |
$459.60 |
| 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 |
$1,225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.08
|
| Rate for Payer: PHCS Commercial |
$1,470.72
|
| Rate for Payer: United Healthcare All Payer |
$1,348.16
|
|
|
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 |
$506.62 |
| 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 |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,194.96
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| 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 |
$506.62
|
| 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 |
$607.94
|
| 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 |
$1,225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,332.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.08
|
| Rate for Payer: PHCS Commercial |
$1,470.72
|
| Rate for Payer: United Healthcare All Payer |
$1,348.16
|
|
|
CARDVASC STRESS ECHO
|
Professional
|
Both
|
$1,972.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$1,183.20 |
| Rate for Payer: Aetna Commercial |
$339.66
|
| Rate for Payer: Ambetter Exchange |
$165.63
|
| Rate for Payer: Anthem Medicaid |
$126.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.76
|
| Rate for Payer: Cash Price |
$986.00
|
| Rate for Payer: Cash Price |
$986.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$165.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.60
|
| Rate for Payer: Molina Healthcare Passport |
$126.08
|
| Rate for Payer: Multiplan PHCS |
$1,183.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$215.32
|
| Rate for Payer: UHCCP Medicaid |
$690.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.63
|
|
|
CARDVASC STRESS ECHO
|
Facility
|
OP
|
$1,972.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$1,893.12 |
| Rate for Payer: Aetna Commercial |
$1,518.44
|
| Rate for Payer: Anthem Medicaid |
$678.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$986.00
|
| Rate for Payer: Cash Price |
$986.00
|
| Rate for Payer: Cigna Commercial |
$1,636.76
|
| Rate for Payer: First Health Commercial |
$1,873.40
|
| Rate for Payer: Humana Commercial |
$1,676.20
|
| Rate for Payer: Humana KY Medicaid |
$678.17
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$685.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,577.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,715.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.68
|
| Rate for Payer: PHCS Commercial |
$1,893.12
|
| Rate for Payer: United Healthcare All Payer |
$1,735.36
|
|
|
CARDVASC STRESS ECHO
|
Facility
|
IP
|
$1,972.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
48000106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$1,893.12 |
| Rate for Payer: Aetna Commercial |
$1,518.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.16
|
| Rate for Payer: Cash Price |
$986.00
|
| Rate for Payer: Cigna Commercial |
$1,636.76
|
| Rate for Payer: First Health Commercial |
$1,873.40
|
| Rate for Payer: Humana Commercial |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,577.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,715.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.68
|
| Rate for Payer: PHCS Commercial |
$1,893.12
|
| Rate for Payer: United Healthcare All Payer |
$1,735.36
|
|
|
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: Ambetter Exchange |
$165.63
|
| Rate for Payer: Anthem Medicaid |
$126.08
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.63
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.76
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$165.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.63
|
| 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 |
$215.32
|
| Rate for Payer: UHCCP Medicaid |
$94.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.34
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.63
|
|
|
CARDVASC STRESS ECHO(T
|
Facility
|
IP
|
$1,702.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
480T0106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$510.60 |
| Max. Negotiated Rate |
$1,633.92 |
| Rate for Payer: Aetna Commercial |
$1,310.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.56
|
| Rate for Payer: Cash Price |
$851.00
|
| Rate for Payer: Cigna Commercial |
$1,412.66
|
| Rate for Payer: First Health Commercial |
$1,616.90
|
| Rate for Payer: Humana Commercial |
$1,446.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,480.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.38
|
| Rate for Payer: PHCS Commercial |
$1,633.92
|
| Rate for Payer: United Healthcare All Payer |
$1,497.76
|
|
|
CARDVASC STRESS ECHO(T
|
Facility
|
OP
|
$1,702.00
|
|
|
Service Code
|
HCPCS 93350
|
| Hospital Charge Code |
480T0106
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$506.62 |
| Max. Negotiated Rate |
$1,633.92 |
| Rate for Payer: Aetna Commercial |
$1,310.54
|
| Rate for Payer: Anthem Medicaid |
$585.32
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$506.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$709.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$683.94
|
| Rate for Payer: Cash Price |
$851.00
|
| Rate for Payer: Cash Price |
$851.00
|
| Rate for Payer: Cigna Commercial |
$1,412.66
|
| Rate for Payer: First Health Commercial |
$1,616.90
|
| Rate for Payer: Humana Commercial |
$1,446.70
|
| Rate for Payer: Humana KY Medicaid |
$585.32
|
| Rate for Payer: Humana Medicare Advantage |
$506.62
|
| Rate for Payer: Kentucky WC Medicaid |
$591.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,480.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.38
|
| Rate for Payer: PHCS Commercial |
$1,633.92
|
| Rate for Payer: United Healthcare All Payer |
$1,497.76
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$38.54 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$4.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Humana KY Medicaid |
$4.47
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$4.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Ambetter Exchange |
$2.65
|
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.18
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$3.45
|
| Rate for Payer: Molina Healthcare Passport |
$3.38
|
| Rate for Payer: Multiplan PHCS |
$36.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3.44
|
| Rate for Payer: UHCCP Medicaid |
$21.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.65
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$12.48 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10.14
|
| Rate for Payer: Cash Price |
$6.50
|
| Rate for Payer: Cigna Commercial |
$10.79
|
| Rate for Payer: First Health Commercial |
$12.35
|
| Rate for Payer: Humana Commercial |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11.44
|
| Rate for Payer: Ohio Health Group HMO |
$9.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8.97
|
| Rate for Payer: PHCS Commercial |
$12.48
|
| Rate for Payer: United Healthcare All Payer |
$11.44
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
510T0365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Ambetter Exchange |
$2.65
|
| Rate for Payer: Anthem Medicaid |
$3.38
|
| Rate for Payer: Buckeye Individual/Medicaid |
$2.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$2.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$3.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$2.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.65
|
| 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 |
$3.44
|
| Rate for Payer: UHCCP Medicaid |
$4.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$3.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$2.65
|
|
|
CAREGIVER HEALTH RISK ASSMT
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS 96161
|
| Hospital Charge Code |
51000365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna Commercial |
$46.20
|
| Rate for Payer: Anthem Medicaid |
$20.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$27.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$38.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$37.17
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$49.80
|
| Rate for Payer: First Health Commercial |
$57.00
|
| Rate for Payer: Humana Commercial |
$51.00
|
| Rate for Payer: Humana KY Medicaid |
$20.63
|
| Rate for Payer: Humana Medicare Advantage |
$27.53
|
| Rate for Payer: Kentucky WC Medicaid |
$20.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$33.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.80
|
| Rate for Payer: Ohio Health Group HMO |
$45.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$48.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$52.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$41.40
|
| Rate for Payer: PHCS Commercial |
$57.60
|
| Rate for Payer: United Healthcare All Payer |
$52.80
|
|
