|
DUPLEX SCAN OF LOWER EXT
|
Facility
|
IP
|
$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 POS/PPO/Traditional |
$963.30
|
| 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: 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 |
$370.50
|
| 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(P
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
921P0007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$383.97 |
| Rate for Payer: Aetna Commercial |
$277.31
|
| Rate for Payer: Anthem Medicaid |
$133.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$35.00
|
| Rate for Payer: Cash Price |
$35.00
|
| 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 |
$42.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$49.00
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.27
|
|
|
DUPLEX SCAN OF LOWER EXT(T
|
Facility
|
IP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
921T0007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.45 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$349.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.15
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
DUPLEX SCAN OF LOWER EXT(T
|
Facility
|
OP
|
$1,165.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
921T0007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.45 |
| Max. Negotiated Rate |
$1,118.40 |
| Rate for Payer: Aetna Commercial |
$897.05
|
| Rate for Payer: Anthem Medicaid |
$400.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$908.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cash Price |
$582.50
|
| Rate for Payer: Cigna Commercial |
$966.95
|
| Rate for Payer: First Health Commercial |
$1,106.75
|
| Rate for Payer: Humana Commercial |
$990.25
|
| Rate for Payer: Humana KY Medicaid |
$400.64
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$404.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$955.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$859.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$408.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,025.20
|
| Rate for Payer: Ohio Health Group HMO |
$873.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.15
|
| Rate for Payer: PHCS Commercial |
$1,118.40
|
| Rate for Payer: United Healthcare All Payer |
$1,025.20
|
|
|
DUPLEX SCAN (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921P0021
|
|
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 (P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
921P0022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$266.25 |
| Rate for Payer: Aetna Commercial |
$249.25
|
| Rate for Payer: Anthem Medicaid |
$89.06
|
| 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 |
$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 |
$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 |
$89.95
|
|
|
DUPLEX SCAN (T
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0021
|
|
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 (T
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
921T0022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Aetna Commercial |
$224.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.98
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$241.53
|
| Rate for Payer: First Health Commercial |
$276.45
|
| Rate for Payer: Humana Commercial |
$247.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.08
|
| Rate for Payer: Ohio Health Group HMO |
$218.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.21
|
| Rate for Payer: PHCS Commercial |
$279.36
|
| Rate for Payer: United Healthcare All Payer |
$256.08
|
|
|
DUPLEX SCAN (T
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
921T0022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$279.36 |
| Rate for Payer: Aetna Commercial |
$224.07
|
| Rate for Payer: Anthem Medicaid |
$100.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$241.53
|
| Rate for Payer: First Health Commercial |
$276.45
|
| Rate for Payer: Humana Commercial |
$247.35
|
| Rate for Payer: Humana KY Medicaid |
$100.07
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$101.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$238.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$214.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$256.08
|
| Rate for Payer: Ohio Health Group HMO |
$218.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$58.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$37.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$90.21
|
| Rate for Payer: PHCS Commercial |
$279.36
|
| Rate for Payer: United Healthcare All Payer |
$256.08
|
|
|
DUPLEX SCAN (T
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0021
|
|
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 UNILATERAL
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$211.31
|
| Rate for Payer: Healthspan PPO |
$197.50
|
| Rate for Payer: Humana Medicaid |
$98.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
|
|
DUPLEX UNILATERAL
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
DUPLEX UNILATERAL
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
DUPLEX UNILATERAL LIMITED
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$1,030.00 |
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,030.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$211.31
|
| Rate for Payer: Healthspan PPO |
$197.50
|
| Rate for Payer: Humana Medicaid |
$98.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| Rate for Payer: Multiplan PHCS |
$618.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$721.00
|
| Rate for Payer: UHCCP Medicaid |
$360.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
|
|
DUPLEX UNILATERAL LIMITED
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem Medicaid |
$354.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Humana KY Medicaid |
$354.22
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$357.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$361.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
DUPLEX UNILATERAL LIMITED
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$988.80 |
| Rate for Payer: Cash Price |
$515.00
|
| Rate for Payer: Aetna Commercial |
$793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$803.40
|
| Rate for Payer: Cigna Commercial |
$854.90
|
| Rate for Payer: First Health Commercial |
$978.50
|
| Rate for Payer: Humana Commercial |
$875.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$844.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$760.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$906.40
|
| Rate for Payer: Ohio Health Group HMO |
$772.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$206.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$133.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$319.30
|
| Rate for Payer: PHCS Commercial |
$988.80
|
| Rate for Payer: United Healthcare All Payer |
$906.40
|
|
|
DUPLEX UNILATERAL LIMITED(P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921P0012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$211.31 |
| Rate for Payer: Humana Medicaid |
$98.98
|
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| 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 |
$211.31
|
| Rate for Payer: Healthspan PPO |
$197.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| 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 |
$99.97
|
|
|
DUPLEX UNILATERAL LIMITED(T
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Aetna Commercial |
$716.10
|
| Rate for Payer: Anthem Medicaid |
$319.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$725.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$771.90
|
| Rate for Payer: First Health Commercial |
$883.50
|
| Rate for Payer: Humana Commercial |
$790.50
|
| Rate for Payer: Humana KY Medicaid |
$319.83
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$762.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$818.40
|
| Rate for Payer: Ohio Health Group HMO |
$697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.30
|
| Rate for Payer: PHCS Commercial |
$892.80
|
| Rate for Payer: United Healthcare All Payer |
$818.40
|
|
|
DUPLEX UNILATERAL LIMITED(T
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Aetna Commercial |
$716.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$725.40
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$771.90
|
| Rate for Payer: First Health Commercial |
$883.50
|
| Rate for Payer: Humana Commercial |
$790.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$762.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$818.40
|
| Rate for Payer: Ohio Health Group HMO |
$697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.30
|
| Rate for Payer: PHCS Commercial |
$892.80
|
| Rate for Payer: United Healthcare All Payer |
$818.40
|
|
|
DUPLEX UNILATERAL (P
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921P0024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$211.31 |
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| 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 |
$211.31
|
| Rate for Payer: Healthspan PPO |
$197.50
|
| Rate for Payer: Humana Medicaid |
$98.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$30.43
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| 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 |
$99.97
|
|
|
DUPLEX UNILATERAL (T
|
Facility
|
IP
|
$930.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Aetna Commercial |
$716.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$725.40
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$771.90
|
| Rate for Payer: First Health Commercial |
$883.50
|
| Rate for Payer: Humana Commercial |
$790.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$762.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$279.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$818.40
|
| Rate for Payer: Ohio Health Group HMO |
$697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.30
|
| Rate for Payer: PHCS Commercial |
$892.80
|
| Rate for Payer: United Healthcare All Payer |
$818.40
|
|
|
DUPLEX UNILATERAL (T
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$95.07 |
| Max. Negotiated Rate |
$892.80 |
| Rate for Payer: Aetna Commercial |
$716.10
|
| Rate for Payer: Anthem Medicaid |
$319.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$95.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$725.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$133.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$128.34
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cash Price |
$465.00
|
| Rate for Payer: Cigna Commercial |
$771.90
|
| Rate for Payer: First Health Commercial |
$883.50
|
| Rate for Payer: Humana Commercial |
$790.50
|
| Rate for Payer: Humana KY Medicaid |
$319.83
|
| Rate for Payer: Humana Medicare Advantage |
$95.07
|
| Rate for Payer: Kentucky WC Medicaid |
$323.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$762.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$686.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$114.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$326.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$818.40
|
| Rate for Payer: Ohio Health Group HMO |
$697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$186.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$120.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$288.30
|
| Rate for Payer: PHCS Commercial |
$892.80
|
| Rate for Payer: United Healthcare All Payer |
$818.40
|
|
|
DUP-SCAN HEMO COMPL BI STD
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921P0017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$240.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Humana Medicaid |
$197.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.60
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Molina Healthcare Passport |
$197.78
|
| Rate for Payer: Multiplan PHCS |
$144.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.00
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
|
|
DUP-SCAN HEMO COMPL BI STD
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921T0017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem Medicaid |
$192.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cigna Commercial |
$464.80
|
| Rate for Payer: First Health Commercial |
$532.00
|
| Rate for Payer: Humana Commercial |
$476.00
|
| Rate for Payer: Humana KY Medicaid |
$192.58
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$194.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$459.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$413.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$196.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$492.80
|
| Rate for Payer: Ohio Health Group HMO |
$420.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$72.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$173.60
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
DUP-SCAN HEMO COMPL BI STD
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
