|
DUPLEX SCAN DIALYSIS GRAFT
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$167.48
|
| Rate for Payer: Anthem Medicaid |
$83.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$624.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cigna Commercial |
$229.34
|
| Rate for Payer: Healthspan PPO |
$178.90
|
| Rate for Payer: Humana Medicaid |
$83.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.98
|
| Rate for Payer: Molina Healthcare Passport |
$83.31
|
| Rate for Payer: Multiplan PHCS |
$374.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$436.80
|
| Rate for Payer: UHCCP Medicaid |
$218.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.14
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
45000311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.04
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$486.72
|
| 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: 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 |
$187.20
|
| 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
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
45000311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem Medicaid |
$200.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Humana KY Medicaid |
$200.84
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$202.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.04
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
DUPLEX SCAN DIALYSIS GRAFT(P
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
921P0019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$229.34 |
| Rate for Payer: Aetna Commercial |
$167.48
|
| Rate for Payer: Anthem Medicaid |
$83.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$40.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cigna Commercial |
$229.34
|
| Rate for Payer: Healthspan PPO |
$178.90
|
| Rate for Payer: Humana Medicaid |
$83.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$17.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.98
|
| Rate for Payer: Molina Healthcare Passport |
$83.31
|
| Rate for Payer: Multiplan PHCS |
$24.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$28.00
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.14
|
|
|
DUPLEX SCAN DIALYSIS GRAFT(T
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
921T0019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem Medicaid |
$200.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Humana KY Medicaid |
$200.84
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$202.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$204.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.04
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
DUPLEX SCAN DIALYSIS GRAFT(T
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
921T0019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$560.64 |
| Rate for Payer: Aetna Commercial |
$449.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$455.52
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cigna Commercial |
$484.72
|
| Rate for Payer: First Health Commercial |
$554.80
|
| Rate for Payer: Humana Commercial |
$496.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$478.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$430.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$175.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$513.92
|
| Rate for Payer: Ohio Health Group HMO |
$438.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$116.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$75.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$181.04
|
| Rate for Payer: PHCS Commercial |
$560.64
|
| Rate for Payer: United Healthcare All Payer |
$513.92
|
|
|
DUPLEX SCAN EXTRACRANIAL ART
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$1,224.96 |
| Rate for Payer: Aetna Commercial |
$982.52
|
| Rate for Payer: Anthem Medicaid |
$438.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna Commercial |
$1,059.08
|
| Rate for Payer: First Health Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial |
$1,084.60
|
| Rate for Payer: Humana KY Medicaid |
$438.82
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,046.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$941.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.56
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
|
DUPLEX SCAN EXTRACRANIAL ART
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100002
|
|
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 EXTRACRANIAL ART
|
Professional
|
Both
|
$1,526.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100002
|
|
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 EXTRACRANIAL ART
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100002
|
|
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 EXTRACRANIAL ART
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$1,224.96 |
| Rate for Payer: Aetna Commercial |
$982.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna Commercial |
$1,059.08
|
| Rate for Payer: First Health Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial |
$1,084.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,046.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$941.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.56
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
|
DUPLEX SCAN EXTRACRANIAL ART(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921P0002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$318.81 |
| Rate for Payer: Aetna Commercial |
$281.14
|
| Rate for Payer: Anthem Medicaid |
$167.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| 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 |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.48
|
|
|
DUPLEX SCAN EXTRACRANIAL ART(T
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$1,224.96 |
| Rate for Payer: Aetna Commercial |
$982.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna Commercial |
$1,059.08
|
| Rate for Payer: First Health Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial |
$1,084.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,046.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$941.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.56
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
|
DUPLEX SCAN EXTRACRANIAL ART(T
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$165.88 |
| Max. Negotiated Rate |
$1,224.96 |
| Rate for Payer: Aetna Commercial |
$982.52
|
| Rate for Payer: Anthem Medicaid |
$438.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cash Price |
$638.00
|
| Rate for Payer: Cigna Commercial |
$1,059.08
|
| Rate for Payer: First Health Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial |
$1,084.60
|
| Rate for Payer: Humana KY Medicaid |
$438.82
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$443.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,046.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$941.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.88
|
| Rate for Payer: Ohio Health Group HMO |
$957.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$255.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$165.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$395.56
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
|
DUPLEX SCAN OF LOWER ARTERIE(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
921P0008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$237.95 |
| Rate for Payer: Aetna Commercial |
$179.66
|
| Rate for Payer: Anthem Medicaid |
$89.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$100.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cash Price |
$50.00
|
| Rate for Payer: Cigna Commercial |
$237.95
|
| Rate for Payer: Healthspan PPO |
$191.91
|
| Rate for Payer: Humana Medicaid |
$89.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.33
|
| Rate for Payer: Molina Healthcare Passport |
$89.54
|
| Rate for Payer: Multiplan PHCS |
$60.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.00
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.44
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$179.66
|
| Rate for Payer: Anthem Medicaid |
$89.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$940.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$237.95
|
| Rate for Payer: Healthspan PPO |
$191.91
|
| Rate for Payer: Humana Medicaid |
$89.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$26.97
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.33
|
| Rate for Payer: Molina Healthcare Passport |
$89.54
|
| Rate for Payer: Multiplan PHCS |
$564.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$658.00
|
| Rate for Payer: UHCCP Medicaid |
$329.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.44
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$902.40 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$282.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.40
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$902.40 |
| Rate for Payer: Aetna Commercial |
$723.80
|
| Rate for Payer: Anthem Medicaid |
$323.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$733.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cigna Commercial |
$780.20
|
| Rate for Payer: First Health Commercial |
$893.00
|
| Rate for Payer: Humana Commercial |
$799.00
|
| Rate for Payer: Humana KY Medicaid |
$323.27
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$326.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$770.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$693.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$329.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$827.20
|
| Rate for Payer: Ohio Health Group HMO |
$705.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$188.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$122.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$291.40
|
| Rate for Payer: PHCS Commercial |
$902.40
|
| Rate for Payer: United Healthcare All Payer |
$827.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIE(T
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
921T0008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIE(T
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
921T0008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$806.40 |
| Rate for Payer: Aetna Commercial |
$646.80
|
| Rate for Payer: Anthem Medicaid |
$288.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$697.20
|
| Rate for Payer: First Health Commercial |
$798.00
|
| Rate for Payer: Humana Commercial |
$714.00
|
| Rate for Payer: Humana KY Medicaid |
$288.88
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$291.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$688.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$619.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$294.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$739.20
|
| Rate for Payer: Ohio Health Group HMO |
$630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$168.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$109.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$260.40
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
DUPLEX SCAN OF LOWER EXT
|
Facility
|
OP
|
$1,235.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$160.55 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Aetna Commercial |
$950.95
|
| Rate for Payer: Anthem Medicaid |
$424.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$963.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$1,025.05
|
| Rate for Payer: First Health Commercial |
$1,173.25
|
| Rate for Payer: Humana Commercial |
$1,049.75
|
| Rate for Payer: Humana KY Medicaid |
$424.72
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$429.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,012.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$911.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$433.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,086.80
|
| Rate for Payer: Ohio Health Group HMO |
$926.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$247.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$160.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$382.85
|
| Rate for Payer: PHCS Commercial |
$1,185.60
|
| Rate for Payer: United Healthcare All Payer |
$1,086.80
|
|
|
DUPLEX SCAN OF LOWER EXT
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$1,235.00 |
| Rate for Payer: Aetna Commercial |
$277.31
|
| Rate for Payer: Anthem Medicaid |
$133.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,235.00
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cash Price |
$617.50
|
| Rate for Payer: Cigna Commercial |
$383.97
|
| Rate for Payer: Healthspan PPO |
$296.22
|
| Rate for Payer: Humana Medicaid |
$133.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$38.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.61
|
| Rate for Payer: Molina Healthcare Passport |
$133.93
|
| Rate for Payer: Multiplan PHCS |
$741.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$864.50
|
| Rate for Payer: UHCCP Medicaid |
$432.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.27
|
|
