|
DUPIXENT 200mg SYRINGE
|
Facility
|
OP
|
$10,363.72
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,347.28 |
| Max. Negotiated Rate |
$9,949.17 |
| Rate for Payer: Ohio Health Group HMO |
$7,772.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,072.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,347.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,212.75
|
| Rate for Payer: PHCS Commercial |
$9,949.17
|
| Rate for Payer: United Healthcare All Payer |
$9,120.07
|
| Rate for Payer: Aetna Commercial |
$7,980.06
|
| Rate for Payer: Anthem Medicaid |
$3,564.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,083.70
|
| Rate for Payer: Cash Price |
$5,181.86
|
| Rate for Payer: Cigna Commercial |
$8,601.89
|
| Rate for Payer: First Health Commercial |
$9,845.53
|
| Rate for Payer: Humana Commercial |
$8,809.16
|
| Rate for Payer: Humana KY Medicaid |
$3,564.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,600.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,498.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,648.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,109.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,635.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,120.07
|
|
|
DUPIXENT 200mg SYRINGE
|
Facility
|
IP
|
$10,363.72
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004116
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,347.28 |
| Max. Negotiated Rate |
$9,949.17 |
| Rate for Payer: Aetna Commercial |
$7,980.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,083.70
|
| Rate for Payer: Cash Price |
$5,181.86
|
| Rate for Payer: Cigna Commercial |
$8,601.89
|
| Rate for Payer: First Health Commercial |
$9,845.53
|
| Rate for Payer: Humana Commercial |
$8,809.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,498.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,648.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,109.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,120.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,772.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,072.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,347.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,212.75
|
| Rate for Payer: PHCS Commercial |
$9,949.17
|
| Rate for Payer: United Healthcare All Payer |
$9,120.07
|
|
|
DUPIXENT 300mg SYRINGE
|
Facility
|
OP
|
$10,363.72
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,347.28 |
| Max. Negotiated Rate |
$9,949.17 |
| Rate for Payer: Aetna Commercial |
$7,980.06
|
| Rate for Payer: Anthem Medicaid |
$3,564.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,083.70
|
| Rate for Payer: Cash Price |
$5,181.86
|
| Rate for Payer: Cigna Commercial |
$8,601.89
|
| Rate for Payer: First Health Commercial |
$9,845.53
|
| Rate for Payer: Humana Commercial |
$8,809.16
|
| Rate for Payer: Humana KY Medicaid |
$3,564.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,600.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,498.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,648.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,109.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,635.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,120.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,772.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,072.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,347.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,212.75
|
| Rate for Payer: PHCS Commercial |
$9,949.17
|
| Rate for Payer: United Healthcare All Payer |
$9,120.07
|
|
|
DUPIXENT 300mg SYRINGE
|
Facility
|
IP
|
$10,363.72
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
25004117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,347.28 |
| Max. Negotiated Rate |
$9,949.17 |
| Rate for Payer: Aetna Commercial |
$7,980.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,083.70
|
| Rate for Payer: Cash Price |
$5,181.86
|
| Rate for Payer: Cigna Commercial |
$8,601.89
|
| Rate for Payer: First Health Commercial |
$9,845.53
|
| Rate for Payer: Humana Commercial |
$8,809.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,498.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,648.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,109.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,120.07
|
| Rate for Payer: Ohio Health Group HMO |
$7,772.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,072.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,347.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,212.75
|
| Rate for Payer: PHCS Commercial |
$9,949.17
|
| Rate for Payer: United Healthcare All Payer |
$9,120.07
|
|
|
DUPLEX COMPLETE
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.66
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
DUPLEX COMPLETE
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$46.44 |
| Max. Negotiated Rate |
$1,286.00 |
| Rate for Payer: Aetna Commercial |
$288.23
|
| Rate for Payer: Anthem Medicaid |
$171.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,286.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$314.83
|
| Rate for Payer: Healthspan PPO |
$307.89
|
| Rate for Payer: Humana Medicaid |
$171.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.21
|
| Rate for Payer: Molina Healthcare Passport |
$171.77
|
| Rate for Payer: Multiplan PHCS |
$771.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.20
|
| Rate for Payer: UHCCP Medicaid |
$450.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.49
|
|
|
DUPLEX COMPLETE
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$46.44 |
| Max. Negotiated Rate |
$1,286.00 |
| Rate for Payer: Aetna Commercial |
$288.23
|
| Rate for Payer: Anthem Medicaid |
$171.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,286.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$314.83
|
| Rate for Payer: Healthspan PPO |
$307.89
|
| Rate for Payer: Humana Medicaid |
$171.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.21
|
| Rate for Payer: Molina Healthcare Passport |
$171.77
|
| Rate for Payer: Multiplan PHCS |
$771.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$900.20
|
| Rate for Payer: UHCCP Medicaid |
$450.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.49
|
|
|
DUPLEX COMPLETE
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92000009
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.86
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
DUPLEX COMPLETE
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.66
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
DUPLEX COMPLETE
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem Medicaid |
$442.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Humana KY Medicaid |
$442.26
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$446.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$451.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.66
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
DUPLEX COMPLETE
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92000009
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem Medicaid |
$414.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Humana KY Medicaid |
$414.74
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$418.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.86
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
DUPLEX COMPLETE
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.18 |
| Max. Negotiated Rate |
$1,234.56 |
| Rate for Payer: Aetna Commercial |
$990.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,003.08
|
| Rate for Payer: Cash Price |
$643.00
|
| Rate for Payer: Cigna Commercial |
$1,067.38
|
| Rate for Payer: First Health Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial |
$1,093.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,054.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$949.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,131.68
|
| Rate for Payer: Ohio Health Group HMO |
$964.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$257.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$167.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$398.66
|
| Rate for Payer: PHCS Commercial |
$1,234.56
|
| Rate for Payer: United Healthcare All Payer |
$1,131.68
|
|
|
DUPLEX COMPLETE (P
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921P0023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$314.83 |
| Rate for Payer: Aetna Commercial |
$288.23
|
| Rate for Payer: Anthem Medicaid |
$171.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$314.83
|
| Rate for Payer: Healthspan PPO |
$307.89
|
| Rate for Payer: Humana Medicaid |
$171.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.21
|
| Rate for Payer: Molina Healthcare Passport |
$171.77
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.49
|
|
|
DUPLEX COMPLETE(P
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921P0011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$314.83 |
| Rate for Payer: Aetna Commercial |
$288.23
|
| Rate for Payer: Anthem Medicaid |
$171.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$80.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cigna Commercial |
$314.83
|
| Rate for Payer: Healthspan PPO |
$307.89
|
| Rate for Payer: Humana Medicaid |
$171.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$46.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$175.21
|
| Rate for Payer: Molina Healthcare Passport |
$171.77
|
| Rate for Payer: Multiplan PHCS |
$48.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$56.00
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.49
|
|
|
DUPLEX COMPLETE (T
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem Medicaid |
$414.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Humana KY Medicaid |
$414.74
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$418.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.86
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
DUPLEX COMPLETE (T
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.86
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
DUPLEX COMPLETE(T
|
Facility
|
OP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem Medicaid |
$414.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Humana KY Medicaid |
$414.74
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$418.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$423.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.86
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
DUPLEX COMPLETE(T
|
Facility
|
IP
|
$1,206.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$156.78 |
| Max. Negotiated Rate |
$1,157.76 |
| Rate for Payer: Aetna Commercial |
$928.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$940.68
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna Commercial |
$1,000.98
|
| Rate for Payer: First Health Commercial |
$1,145.70
|
| Rate for Payer: Humana Commercial |
$1,025.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$988.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$890.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$361.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,061.28
|
| Rate for Payer: Ohio Health Group HMO |
$904.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$241.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.86
|
| Rate for Payer: PHCS Commercial |
$1,157.76
|
| Rate for Payer: United Healthcare All Payer |
$1,061.28
|
|
|
DUPLEX SCAN
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$519.36 |
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Anthem Medicaid |
$186.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$449.03
|
| Rate for Payer: First Health Commercial |
$513.95
|
| Rate for Payer: Humana Commercial |
$459.85
|
| Rate for Payer: Humana KY Medicaid |
$186.05
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$187.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$189.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.08
|
| Rate for Payer: Ohio Health Group HMO |
$405.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.71
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
DUPLEX SCAN
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$1,526.00 |
| Rate for Payer: Aetna Commercial |
$281.14
|
| Rate for Payer: Anthem Medicaid |
$167.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,526.00
|
| Rate for Payer: Cash Price |
$763.00
|
| Rate for Payer: Cash Price |
$763.00
|
| Rate for Payer: Cigna Commercial |
$318.81
|
| Rate for Payer: Healthspan PPO |
$300.31
|
| Rate for Payer: Humana Medicaid |
$167.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$40.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.16
|
| Rate for Payer: Molina Healthcare Passport |
$167.80
|
| Rate for Payer: Multiplan PHCS |
$915.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,068.20
|
| Rate for Payer: UHCCP Medicaid |
$534.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.48
|
|
|
DUPLEX SCAN
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$1,464.96 |
| Rate for Payer: Aetna Commercial |
$1,175.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.28
|
| Rate for Payer: Cash Price |
$763.00
|
| Rate for Payer: Cigna Commercial |
$1,266.58
|
| Rate for Payer: First Health Commercial |
$1,449.70
|
| Rate for Payer: Humana Commercial |
$1,297.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$457.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.06
|
| Rate for Payer: PHCS Commercial |
$1,464.96
|
| Rate for Payer: United Healthcare All Payer |
$1,342.88
|
|
|
DUPLEX SCAN
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$1,464.96 |
| Rate for Payer: Aetna Commercial |
$1,175.02
|
| Rate for Payer: Anthem Medicaid |
$524.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$763.00
|
| Rate for Payer: Cash Price |
$763.00
|
| Rate for Payer: Cigna Commercial |
$1,266.58
|
| Rate for Payer: First Health Commercial |
$1,449.70
|
| Rate for Payer: Humana Commercial |
$1,297.10
|
| Rate for Payer: Humana KY Medicaid |
$524.79
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$530.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$535.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,342.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.06
|
| Rate for Payer: PHCS Commercial |
$1,464.96
|
| Rate for Payer: United Healthcare All Payer |
$1,342.88
|
|
|
DUPLEX SCAN
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$519.36 |
| Rate for Payer: Aetna Commercial |
$416.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$449.03
|
| Rate for Payer: First Health Commercial |
$513.95
|
| Rate for Payer: Humana Commercial |
$459.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$443.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$399.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$162.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$476.08
|
| Rate for Payer: Ohio Health Group HMO |
$405.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$108.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$70.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$167.71
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
DUPLEX SCAN
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$541.00 |
| Rate for Payer: Aetna Commercial |
$249.25
|
| Rate for Payer: Anthem Medicaid |
$89.06
|
| Rate for Payer: Buckeye Medicare Advantage |
$541.00
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cigna Commercial |
$205.36
|
| Rate for Payer: Healthspan PPO |
$266.25
|
| Rate for Payer: Humana Medicaid |
$89.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$27.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$90.84
|
| Rate for Payer: Molina Healthcare Passport |
$89.06
|
| Rate for Payer: Multiplan PHCS |
$324.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$378.70
|
| Rate for Payer: UHCCP Medicaid |
$189.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.95
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$81.12 |
| Max. Negotiated Rate |
$599.04 |
| Rate for Payer: Aetna Commercial |
$480.48
|
| Rate for Payer: Anthem Medicaid |
$214.59
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$486.72
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$517.92
|
| Rate for Payer: First Health Commercial |
$592.80
|
| Rate for Payer: Humana Commercial |
$530.40
|
| Rate for Payer: Humana KY Medicaid |
$214.59
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$216.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$511.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$460.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$549.12
|
| Rate for Payer: Ohio Health Group HMO |
$468.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$81.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$193.44
|
| Rate for Payer: PHCS Commercial |
$599.04
|
| Rate for Payer: United Healthcare All Payer |
$549.12
|
|
