|
DUPLEX SCAN EXTRACRANIAL ART
|
Professional
|
Both
|
$1,609.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92100002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$965.40 |
| 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 |
$804.50
|
| Rate for Payer: Cash Price |
$804.50
|
| 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 |
$965.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.75
|
| Rate for Payer: UHCCP Medicaid |
$563.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.27
|
|
|
DUPLEX SCAN EXTRACRANIAL ART
|
Facility
|
OP
|
$1,276.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
92000005
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$223.34 |
| 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 |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$995.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| 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 |
$223.34
|
| 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 |
$268.01
|
| 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 |
$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
|
|
|
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: 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 |
$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: 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 |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.75
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.27
|
|
|
DUPLEX SCAN EXTRACRANIAL ART(T
|
Facility
|
OP
|
$1,359.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,304.64 |
| Rate for Payer: Aetna Commercial |
$1,046.43
|
| Rate for Payer: Anthem Medicaid |
$467.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,060.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cigna Commercial |
$1,127.97
|
| Rate for Payer: First Health Commercial |
$1,291.05
|
| Rate for Payer: Humana Commercial |
$1,155.15
|
| Rate for Payer: Humana KY Medicaid |
$467.36
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$472.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,114.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,002.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$476.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,195.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,019.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$937.71
|
| Rate for Payer: PHCS Commercial |
$1,304.64
|
| Rate for Payer: United Healthcare All Payer |
$1,195.92
|
|
|
DUPLEX SCAN EXTRACRANIAL ART(T
|
Facility
|
IP
|
$1,359.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0002
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$407.70 |
| Max. Negotiated Rate |
$1,304.64 |
| Rate for Payer: Aetna Commercial |
$1,046.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,060.02
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cigna Commercial |
$1,127.97
|
| Rate for Payer: First Health Commercial |
$1,291.05
|
| Rate for Payer: Humana Commercial |
$1,155.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,114.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,002.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$407.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,195.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,019.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$937.71
|
| Rate for Payer: PHCS Commercial |
$1,304.64
|
| Rate for Payer: United Healthcare All Payer |
$1,195.92
|
|
|
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: Ambetter Exchange |
$126.95
|
| Rate for Payer: Anthem Medicaid |
$89.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.34
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$126.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.95
|
| 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 |
$165.03
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.95
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$655.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Professional
|
Both
|
$994.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$26.97 |
| Max. Negotiated Rate |
$596.40 |
| Rate for Payer: Aetna Commercial |
$179.66
|
| Rate for Payer: Ambetter Exchange |
$126.95
|
| Rate for Payer: Anthem Medicaid |
$89.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$152.34
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$126.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.95
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.33
|
| Rate for Payer: Molina Healthcare Passport |
$89.54
|
| Rate for Payer: Multiplan PHCS |
$596.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$165.03
|
| Rate for Payer: UHCCP Medicaid |
$347.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.44
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.95
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$298.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.86
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92000008
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$252.00 |
| 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 |
$672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.60
|
| Rate for Payer: PHCS Commercial |
$806.40
|
| Rate for Payer: United Healthcare All Payer |
$739.20
|
|
|
DUPLEX SCAN OF LOWER ARTERIES
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
92100008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$954.24 |
| Rate for Payer: Aetna Commercial |
$765.38
|
| Rate for Payer: Anthem Medicaid |
$341.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$775.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cash Price |
$497.00
|
| Rate for Payer: Cigna Commercial |
$825.02
|
| Rate for Payer: First Health Commercial |
$944.30
|
| Rate for Payer: Humana Commercial |
$844.90
|
| Rate for Payer: Humana KY Medicaid |
$341.84
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$345.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$815.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$733.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$348.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$874.72
|
| Rate for Payer: Ohio Health Group HMO |
$745.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.86
|
| Rate for Payer: PHCS Commercial |
$954.24
|
| Rate for Payer: United Healthcare All Payer |
$874.72
|
|
|
DUPLEX SCAN OF LOWER ARTERIE(T
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
921T0008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem Medicaid |
$307.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Humana KY Medicaid |
$307.45
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$310.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$313.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.86
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
DUPLEX SCAN OF LOWER ARTERIE(T
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
HCPCS 93926
|
| Hospital Charge Code |
921T0008
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$858.24 |
| Rate for Payer: Aetna Commercial |
$688.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$697.32
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$742.02
|
| Rate for Payer: First Health Commercial |
$849.30
|
| Rate for Payer: Humana Commercial |
$759.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$733.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$659.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$786.72
|
| Rate for Payer: Ohio Health Group HMO |
$670.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$777.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.86
|
| Rate for Payer: PHCS Commercial |
$858.24
|
| Rate for Payer: United Healthcare All Payer |
$786.72
|
|
|
DUPLEX SCAN OF LOWER EXT
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$393.30 |
| Max. Negotiated Rate |
$1,258.56 |
| Rate for Payer: Aetna Commercial |
$1,009.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,022.58
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Cigna Commercial |
$1,088.13
|
| Rate for Payer: First Health Commercial |
$1,245.45
|
| Rate for Payer: Humana Commercial |
$1,114.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$967.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,153.68
|
| Rate for Payer: Ohio Health Group HMO |
$983.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,048.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$904.59
|
| Rate for Payer: PHCS Commercial |
$1,258.56
|
| Rate for Payer: United Healthcare All Payer |
$1,153.68
|
|
|
DUPLEX SCAN OF LOWER EXT
|
Professional
|
Both
|
$1,311.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$786.60 |
| Rate for Payer: Aetna Commercial |
$277.31
|
| Rate for Payer: Ambetter Exchange |
$211.33
|
| Rate for Payer: Anthem Medicaid |
$133.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$211.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$211.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.60
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Cash Price |
$655.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$211.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.33
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$136.61
|
| Rate for Payer: Molina Healthcare Passport |
$133.93
|
| Rate for Payer: Multiplan PHCS |
$786.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$274.73
|
| Rate for Payer: UHCCP Medicaid |
$458.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$211.33
|
|
|
DUPLEX SCAN OF LOWER EXT
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
92100007
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,258.56 |
| Rate for Payer: Aetna Commercial |
$1,009.47
|
| Rate for Payer: Anthem Medicaid |
$450.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,022.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Cash Price |
$655.50
|
| Rate for Payer: Cigna Commercial |
$1,088.13
|
| Rate for Payer: First Health Commercial |
$1,245.45
|
| Rate for Payer: Humana Commercial |
$1,114.35
|
| Rate for Payer: Humana KY Medicaid |
$450.85
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$455.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,075.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$967.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$459.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,153.68
|
| Rate for Payer: Ohio Health Group HMO |
$983.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,048.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,140.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$904.59
|
| Rate for Payer: PHCS Commercial |
$1,258.56
|
| Rate for Payer: United Healthcare All Payer |
$1,153.68
|
|
|
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: Ambetter Exchange |
$211.33
|
| Rate for Payer: Anthem Medicaid |
$133.93
|
| Rate for Payer: Buckeye Individual/Medicaid |
$211.33
|
| Rate for Payer: Buckeye Medicare Advantage |
$211.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$253.60
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$211.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$211.33
|
| 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 |
$274.73
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$135.27
|
| Rate for Payer: Wellcare Medicare Advantage |
$211.33
|
|
|
DUPLEX SCAN OF LOWER EXT(T
|
Facility
|
OP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
921T0007
|
|
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 SCAN OF LOWER EXT(T
|
Facility
|
IP
|
$1,241.00
|
|
|
Service Code
|
HCPCS 93925
|
| Hospital Charge Code |
921T0007
|
|
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 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: 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 |
$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: 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 |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$218.75
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$169.48
|
| Rate for Payer: Wellcare Medicare Advantage |
$168.27
|
|
|
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: 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 |
$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: 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 |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$143.21
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$89.95
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.16
|
|
|
DUPLEX SCAN (T
|
Facility
|
IP
|
$1,313.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$393.90 |
| Max. Negotiated Rate |
$1,260.48 |
| Rate for Payer: Aetna Commercial |
$1,011.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.14
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$1,089.79
|
| Rate for Payer: First Health Commercial |
$1,247.35
|
| Rate for Payer: Humana Commercial |
$1,116.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,076.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$393.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,155.44
|
| Rate for Payer: Ohio Health Group HMO |
$984.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.97
|
| Rate for Payer: PHCS Commercial |
$1,260.48
|
| Rate for Payer: United Healthcare All Payer |
$1,155.44
|
|
|
DUPLEX SCAN (T
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
921T0022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| 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 |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$226.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| 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 |
$98.26
|
| 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 |
$117.91
|
| 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 |
$232.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.79
|
| Rate for Payer: PHCS Commercial |
$279.36
|
| Rate for Payer: United Healthcare All Payer |
$256.08
|
|
|
DUPLEX SCAN (T
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
HCPCS 93882
|
| Hospital Charge Code |
921T0022
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$87.30 |
| 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 |
$232.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$200.79
|
| Rate for Payer: PHCS Commercial |
$279.36
|
| Rate for Payer: United Healthcare All Payer |
$256.08
|
|
|
DUPLEX SCAN (T
|
Facility
|
OP
|
$1,313.00
|
|
|
Service Code
|
HCPCS 93880
|
| Hospital Charge Code |
921T0021
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$1,260.48 |
| Rate for Payer: Aetna Commercial |
$1,011.01
|
| Rate for Payer: Anthem Medicaid |
$451.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,024.14
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cash Price |
$656.50
|
| Rate for Payer: Cigna Commercial |
$1,089.79
|
| Rate for Payer: First Health Commercial |
$1,247.35
|
| Rate for Payer: Humana Commercial |
$1,116.05
|
| Rate for Payer: Humana KY Medicaid |
$451.54
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$456.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,076.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$968.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,155.44
|
| Rate for Payer: Ohio Health Group HMO |
$984.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,142.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.97
|
| Rate for Payer: PHCS Commercial |
$1,260.48
|
| Rate for Payer: United Healthcare All Payer |
$1,155.44
|
|
