|
DUPLEX COMPLETE
|
Facility
|
OP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem Medicaid |
$469.08
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Humana KY Medicaid |
$469.08
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$473.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$478.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.16
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
DUPLEX COMPLETE
|
Facility
|
IP
|
$1,364.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
92100011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$409.20 |
| Max. Negotiated Rate |
$1,309.44 |
| Rate for Payer: Aetna Commercial |
$1,050.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,063.92
|
| Rate for Payer: Cash Price |
$682.00
|
| Rate for Payer: Cigna Commercial |
$1,132.12
|
| Rate for Payer: First Health Commercial |
$1,295.80
|
| Rate for Payer: Humana Commercial |
$1,159.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,118.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,006.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$409.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,200.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,023.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$941.16
|
| Rate for Payer: PHCS Commercial |
$1,309.44
|
| Rate for Payer: United Healthcare All Payer |
$1,200.32
|
|
|
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: Ambetter Exchange |
$165.29
|
| Rate for Payer: Anthem Medicaid |
$171.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.35
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$165.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| 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 |
$214.88
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.29
|
|
|
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: Ambetter Exchange |
$165.29
|
| Rate for Payer: Anthem Medicaid |
$171.77
|
| Rate for Payer: Buckeye Individual/Medicaid |
$165.29
|
| Rate for Payer: Buckeye Medicare Advantage |
$165.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$198.35
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$165.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$165.29
|
| 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 |
$214.88
|
| Rate for Payer: UHCCP Medicaid |
$28.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$173.49
|
| Rate for Payer: Wellcare Medicare Advantage |
$165.29
|
|
|
DUPLEX COMPLETE (T
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$372.30 |
| Max. Negotiated Rate |
$1,191.36 |
| Rate for Payer: Aetna Commercial |
$955.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.98
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$1,030.03
|
| Rate for Payer: First Health Commercial |
$1,178.95
|
| Rate for Payer: Humana Commercial |
$1,054.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,017.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$372.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.08
|
| Rate for Payer: Ohio Health Group HMO |
$930.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,079.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.29
|
| Rate for Payer: PHCS Commercial |
$1,191.36
|
| Rate for Payer: United Healthcare All Payer |
$1,092.08
|
|
|
DUPLEX COMPLETE (T
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0023
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,191.36 |
| Rate for Payer: Aetna Commercial |
$955.57
|
| Rate for Payer: Anthem Medicaid |
$426.78
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$967.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cash Price |
$620.50
|
| Rate for Payer: Cigna Commercial |
$1,030.03
|
| Rate for Payer: First Health Commercial |
$1,178.95
|
| Rate for Payer: Humana Commercial |
$1,054.85
|
| Rate for Payer: Humana KY Medicaid |
$426.78
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$431.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,017.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$915.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$435.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,092.08
|
| Rate for Payer: Ohio Health Group HMO |
$930.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,079.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$856.29
|
| Rate for Payer: PHCS Commercial |
$1,191.36
|
| Rate for Payer: United Healthcare All Payer |
$1,092.08
|
|
|
DUPLEX COMPLETE(T
|
Facility
|
OP
|
$1,284.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,232.64 |
| Rate for Payer: Aetna Commercial |
$988.68
|
| Rate for Payer: Anthem Medicaid |
$441.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,001.52
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$1,065.72
|
| Rate for Payer: First Health Commercial |
$1,219.80
|
| Rate for Payer: Humana Commercial |
$1,091.40
|
| Rate for Payer: Humana KY Medicaid |
$441.57
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$446.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,052.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$947.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$450.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,129.92
|
| Rate for Payer: Ohio Health Group HMO |
$963.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$885.96
|
| Rate for Payer: PHCS Commercial |
$1,232.64
|
| Rate for Payer: United Healthcare All Payer |
$1,129.92
|
|
|
DUPLEX COMPLETE(T
|
Facility
|
IP
|
$1,284.00
|
|
|
Service Code
|
HCPCS 93970
|
| Hospital Charge Code |
921T0011
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,232.64 |
| Rate for Payer: Aetna Commercial |
$988.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,001.52
|
| Rate for Payer: Cash Price |
$642.00
|
| Rate for Payer: Cigna Commercial |
$1,065.72
|
| Rate for Payer: First Health Commercial |
$1,219.80
|
| Rate for Payer: Humana Commercial |
$1,091.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,052.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$947.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$385.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,129.92
|
| Rate for Payer: Ohio Health Group HMO |
$963.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,027.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,117.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$885.96
|
| Rate for Payer: PHCS Commercial |
$1,232.64
|
| Rate for Payer: United Healthcare All Payer |
$1,129.92
|
|
|
DUPLEX SCAN
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$937.80 |
| Rate for Payer: Aetna Commercial |
$281.14
|
| Rate for Payer: Ambetter Exchange |
$168.27
|
| Rate for Payer: Anthem Medicaid |
$167.80
|
| Rate for Payer: Buckeye Individual/Medicaid |
$168.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$168.27
|
| Rate for Payer: CareSource Just4Me Medicare |
$201.92
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$168.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$168.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$171.16
|
| Rate for Payer: Molina Healthcare Passport |
$167.80
|
| Rate for Payer: Multiplan PHCS |
$937.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.75
|
| Rate for Payer: UHCCP Medicaid |
$547.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.27
|
|
|
DUPLEX SCAN
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$421.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 |
$432.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.29
|
| 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 |
$324.60 |
| Rate for Payer: Aetna Commercial |
$249.25
|
| Rate for Payer: Ambetter Exchange |
$110.16
|
| Rate for Payer: Anthem Medicaid |
$89.06
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.16
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.19
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$110.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.16
|
| 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 |
$143.21
|
| Rate for Payer: UHCCP Medicaid |
$189.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.16
|
|
|
DUPLEX SCAN
|
Facility
|
OP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,500.48 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem Medicaid |
$537.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Humana KY Medicaid |
$537.52
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$542.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,359.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,078.47
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
DUPLEX SCAN
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
92100022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$162.30 |
| 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 |
$432.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$373.29
|
| Rate for Payer: PHCS Commercial |
$519.36
|
| Rate for Payer: United Healthcare All Payer |
$476.08
|
|
|
DUPLEX SCAN
|
Facility
|
IP
|
$1,563.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$468.90 |
| Max. Negotiated Rate |
$1,500.48 |
| Rate for Payer: Aetna Commercial |
$1,203.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.14
|
| Rate for Payer: Cash Price |
$781.50
|
| Rate for Payer: Cigna Commercial |
$1,297.29
|
| Rate for Payer: First Health Commercial |
$1,484.85
|
| Rate for Payer: Humana Commercial |
$1,328.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,375.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,172.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,250.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,359.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,078.47
|
| Rate for Payer: PHCS Commercial |
$1,500.48
|
| Rate for Payer: United Healthcare All Payer |
$1,375.44
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
IP
|
$662.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$198.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.78
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Professional
|
Both
|
$662.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$17.46 |
| Max. Negotiated Rate |
$397.20 |
| Rate for Payer: Aetna Commercial |
$167.48
|
| Rate for Payer: Ambetter Exchange |
$129.72
|
| Rate for Payer: Anthem Medicaid |
$83.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$155.66
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$129.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$84.98
|
| Rate for Payer: Molina Healthcare Passport |
$83.31
|
| Rate for Payer: Multiplan PHCS |
$397.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.64
|
| Rate for Payer: UHCCP Medicaid |
$231.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.72
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
OP
|
$662.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
92100019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$635.52 |
| Rate for Payer: Aetna Commercial |
$509.74
|
| Rate for Payer: Anthem Medicaid |
$227.66
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$516.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cash Price |
$331.00
|
| Rate for Payer: Cigna Commercial |
$549.46
|
| Rate for Payer: First Health Commercial |
$628.90
|
| Rate for Payer: Humana Commercial |
$562.70
|
| Rate for Payer: Humana KY Medicaid |
$227.66
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$229.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$542.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$488.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$232.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$582.56
|
| Rate for Payer: Ohio Health Group HMO |
$496.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$529.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$575.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$456.78
|
| Rate for Payer: PHCS Commercial |
$635.52
|
| Rate for Payer: United Healthcare All Payer |
$582.56
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
45000311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.60 |
| Max. Negotiated Rate |
$597.12 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.16
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$516.26
|
| Rate for Payer: First Health Commercial |
$590.90
|
| Rate for Payer: Humana Commercial |
$528.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.36
|
| Rate for Payer: Ohio Health Group HMO |
$466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.18
|
| Rate for Payer: PHCS Commercial |
$597.12
|
| Rate for Payer: United Healthcare All Payer |
$547.36
|
|
|
DUPLEX SCAN DIALYSIS GRAFT
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
45000311
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Anthem Medicaid |
$213.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$516.26
|
| Rate for Payer: First Health Commercial |
$590.90
|
| Rate for Payer: Humana Commercial |
$528.70
|
| Rate for Payer: Humana KY Medicaid |
$213.91
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$216.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.36
|
| Rate for Payer: Ohio Health Group HMO |
$466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.18
|
| Rate for Payer: PHCS Commercial |
$597.12
|
| Rate for Payer: United Healthcare All Payer |
$547.36
|
|
|
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: Ambetter Exchange |
$129.72
|
| Rate for Payer: Anthem Medicaid |
$83.31
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$155.66
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$129.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.72
|
| 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 |
$168.64
|
| Rate for Payer: UHCCP Medicaid |
$14.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$84.14
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.72
|
|
|
DUPLEX SCAN DIALYSIS GRAFT(T
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
921T0019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$597.12 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Anthem Medicaid |
$213.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$516.26
|
| Rate for Payer: First Health Commercial |
$590.90
|
| Rate for Payer: Humana Commercial |
$528.70
|
| Rate for Payer: Humana KY Medicaid |
$213.91
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$216.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$218.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.36
|
| Rate for Payer: Ohio Health Group HMO |
$466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.18
|
| Rate for Payer: PHCS Commercial |
$597.12
|
| Rate for Payer: United Healthcare All Payer |
$547.36
|
|
|
DUPLEX SCAN DIALYSIS GRAFT(T
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
HCPCS 93990
|
| Hospital Charge Code |
921T0019
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$186.60 |
| Max. Negotiated Rate |
$597.12 |
| Rate for Payer: Aetna Commercial |
$478.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$485.16
|
| Rate for Payer: Cash Price |
$311.00
|
| Rate for Payer: Cigna Commercial |
$516.26
|
| Rate for Payer: First Health Commercial |
$590.90
|
| Rate for Payer: Humana Commercial |
$528.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$510.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$459.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$547.36
|
| Rate for Payer: Ohio Health Group HMO |
$466.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$497.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$429.18
|
| Rate for Payer: PHCS Commercial |
$597.12
|
| Rate for Payer: United Healthcare All Payer |
$547.36
|
|
|
DUPLEX SCAN EXTRACRANIAL ART
|
Facility
|
IP
|
$1,609.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$482.70 |
| Max. Negotiated Rate |
$1,544.64 |
| Rate for Payer: Aetna Commercial |
$1,238.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,255.02
|
| Rate for Payer: Cash Price |
$804.50
|
| Rate for Payer: Cigna Commercial |
$1,335.47
|
| Rate for Payer: First Health Commercial |
$1,528.55
|
| Rate for Payer: Humana Commercial |
$1,367.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,319.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,187.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$482.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,415.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,206.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.21
|
| Rate for Payer: PHCS Commercial |
$1,544.64
|
| Rate for Payer: United Healthcare All Payer |
$1,415.92
|
|
|
DUPLEX SCAN EXTRACRANIAL ART
|
Facility
|
OP
|
$1,609.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,544.64 |
| Rate for Payer: Aetna Commercial |
$1,238.93
|
| Rate for Payer: Anthem Medicaid |
$553.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,255.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$804.50
|
| Rate for Payer: Cash Price |
$804.50
|
| Rate for Payer: Cigna Commercial |
$1,335.47
|
| Rate for Payer: First Health Commercial |
$1,528.55
|
| Rate for Payer: Humana Commercial |
$1,367.65
|
| Rate for Payer: Humana KY Medicaid |
$553.34
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$558.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,319.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,187.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$564.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,415.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,206.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.21
|
| Rate for Payer: PHCS Commercial |
$1,544.64
|
| Rate for Payer: United Healthcare All Payer |
$1,415.92
|
|
|
DUPLEX SCAN EXTRACRANIAL ART
|
Facility
|
IP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$382.80 |
| 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 |
$1,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,110.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$880.44
|
| Rate for Payer: PHCS Commercial |
$1,224.96
|
| Rate for Payer: United Healthcare All Payer |
$1,122.88
|
|
