|
DUPLEX UNILATERAL
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem Medicaid |
$363.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Humana KY Medicaid |
$363.50
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$367.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$370.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
DUPLEX UNILATERAL
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$634.20 |
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Ambetter Exchange |
$105.81
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.97
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cash Price |
$528.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$105.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| Rate for Payer: Multiplan PHCS |
$634.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.55
|
| Rate for Payer: UHCCP Medicaid |
$369.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.81
|
|
|
DUPLEX UNILATERAL
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$317.10 |
| Max. Negotiated Rate |
$1,014.72 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$824.46
|
| Rate for Payer: Cash Price |
$528.50
|
| Rate for Payer: Cigna Commercial |
$877.31
|
| Rate for Payer: First Health Commercial |
$1,004.15
|
| Rate for Payer: Humana Commercial |
$898.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$866.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$780.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$930.16
|
| Rate for Payer: Ohio Health Group HMO |
$792.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$919.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$729.33
|
| Rate for Payer: PHCS Commercial |
$1,014.72
|
| Rate for Payer: United Healthcare All Payer |
$930.16
|
|
|
DUPLEX UNILATERAL LIMITED
|
Facility
|
IP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$327.30 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.98
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$949.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.79
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
DUPLEX UNILATERAL LIMITED
|
Professional
|
Both
|
$1,091.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$654.60 |
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Ambetter Exchange |
$105.81
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.97
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$105.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.81
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$100.96
|
| Rate for Payer: Molina Healthcare Passport |
$98.98
|
| Rate for Payer: Multiplan PHCS |
$654.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$137.55
|
| Rate for Payer: UHCCP Medicaid |
$381.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.81
|
|
|
DUPLEX UNILATERAL LIMITED
|
Facility
|
OP
|
$1,091.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
92100012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,047.36 |
| Rate for Payer: Aetna Commercial |
$840.07
|
| Rate for Payer: Anthem Medicaid |
$375.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$850.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cash Price |
$545.50
|
| Rate for Payer: Cigna Commercial |
$905.53
|
| Rate for Payer: First Health Commercial |
$1,036.45
|
| Rate for Payer: Humana Commercial |
$927.35
|
| Rate for Payer: Humana KY Medicaid |
$375.19
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$379.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$894.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.08
|
| Rate for Payer: Ohio Health Group HMO |
$818.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$949.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$752.79
|
| Rate for Payer: PHCS Commercial |
$1,047.36
|
| Rate for Payer: United Healthcare All Payer |
$960.08
|
|
|
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: Aetna Commercial |
$184.89
|
| Rate for Payer: Ambetter Exchange |
$105.81
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.97
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$105.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.81
|
| 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 |
$137.55
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.81
|
|
|
DUPLEX UNILATERAL LIMITED(T
|
Facility
|
IP
|
$991.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$297.30 |
| Max. Negotiated Rate |
$951.36 |
| Rate for Payer: Aetna Commercial |
$763.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$772.98
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$822.53
|
| Rate for Payer: First Health Commercial |
$941.45
|
| Rate for Payer: Humana Commercial |
$842.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$812.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$731.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.08
|
| Rate for Payer: Ohio Health Group HMO |
$743.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.79
|
| Rate for Payer: PHCS Commercial |
$951.36
|
| Rate for Payer: United Healthcare All Payer |
$872.08
|
|
|
DUPLEX UNILATERAL LIMITED(T
|
Facility
|
OP
|
$991.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0012
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$951.36 |
| Rate for Payer: Aetna Commercial |
$763.07
|
| Rate for Payer: Anthem Medicaid |
$340.80
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$772.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cash Price |
$495.50
|
| Rate for Payer: Cigna Commercial |
$822.53
|
| Rate for Payer: First Health Commercial |
$941.45
|
| Rate for Payer: Humana Commercial |
$842.35
|
| Rate for Payer: Humana KY Medicaid |
$340.80
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$344.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$812.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$731.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$347.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$872.08
|
| Rate for Payer: Ohio Health Group HMO |
$743.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.79
|
| Rate for Payer: PHCS Commercial |
$951.36
|
| Rate for Payer: United Healthcare All Payer |
$872.08
|
|
|
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: Ambetter Exchange |
$105.81
|
| Rate for Payer: Anthem Medicaid |
$98.98
|
| Rate for Payer: Buckeye Individual/Medicaid |
$105.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$105.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$126.97
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$105.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.81
|
| 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 |
$137.55
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$99.97
|
| Rate for Payer: Wellcare Medicare Advantage |
$105.81
|
|
|
DUPLEX UNILATERAL (T
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$287.10 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$287.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$832.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.33
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
DUPLEX UNILATERAL (T
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
HCPCS 93971
|
| Hospital Charge Code |
921T0024
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$918.72 |
| Rate for Payer: Aetna Commercial |
$736.89
|
| Rate for Payer: Anthem Medicaid |
$329.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$746.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna Commercial |
$794.31
|
| Rate for Payer: First Health Commercial |
$909.15
|
| Rate for Payer: Humana Commercial |
$813.45
|
| Rate for Payer: Humana KY Medicaid |
$329.11
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$332.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$784.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$706.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$335.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$842.16
|
| Rate for Payer: Ohio Health Group HMO |
$717.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$765.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$832.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$660.33
|
| Rate for Payer: PHCS Commercial |
$918.72
|
| Rate for Payer: United Healthcare All Payer |
$842.16
|
|
|
DUP-SCAN HEMO COMPL BI STD
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: Ambetter Exchange |
$220.45
|
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.54
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Humana Medicaid |
$197.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$55.60
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$220.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$201.74
|
| Rate for Payer: Molina Healthcare Passport |
$197.78
|
| Rate for Payer: Multiplan PHCS |
$480.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$286.58
|
| Rate for Payer: UHCCP Medicaid |
$280.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.45
|
|
|
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 |
$192.58 |
| 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 |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| 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 |
$223.34
|
| 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 |
$268.01
|
| 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 |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| Rate for Payer: PHCS Commercial |
$537.60
|
| Rate for Payer: United Healthcare All Payer |
$492.80
|
|
|
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 |
$286.58 |
| Rate for Payer: Ambetter Exchange |
$220.45
|
| Rate for Payer: Anthem Medicaid |
$197.78
|
| Rate for Payer: Buckeye Individual/Medicaid |
$220.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$220.45
|
| Rate for Payer: CareSource Just4Me Medicare |
$264.54
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$220.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.45
|
| 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 |
$286.58
|
| Rate for Payer: UHCCP Medicaid |
$84.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$199.76
|
| Rate for Payer: Wellcare Medicare Advantage |
$220.45
|
|
|
DUP-SCAN HEMO COMPL BI STD
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
921T0017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$537.60 |
| Rate for Payer: Aetna Commercial |
$431.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$436.80
|
| 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: 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 |
$168.00
|
| 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 |
$448.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$386.40
|
| 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 |
$223.34 |
| 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 |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| 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 |
$223.34
|
| 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 |
$268.01
|
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
DUP-SCAN HEMO COMPL BI STD
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS 93985
|
| Hospital Charge Code |
92100017
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| 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: 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 |
$240.00
|
| 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 |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
DUP-SCAN HEMO COMPL UNI
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
92100020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem Medicaid |
$239.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$542.88
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Humana KY Medicaid |
$239.35
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$241.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$244.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.24
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
DUP-SCAN HEMO COMPL UNI
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
92100020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Ambetter Exchange |
$129.39
|
| Rate for Payer: Anthem Medicaid |
$114.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$155.27
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Humana Medicaid |
$114.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$129.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.15
|
| Rate for Payer: Molina Healthcare Passport |
$114.85
|
| Rate for Payer: Multiplan PHCS |
$417.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.21
|
| Rate for Payer: UHCCP Medicaid |
$243.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.39
|
|
|
DUP-SCAN HEMO COMPL UNI
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
92100020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$668.16 |
| Rate for Payer: Aetna Commercial |
$535.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$542.88
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$577.68
|
| Rate for Payer: First Health Commercial |
$661.20
|
| Rate for Payer: Humana Commercial |
$591.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$570.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$513.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$208.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$612.48
|
| Rate for Payer: Ohio Health Group HMO |
$522.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$480.24
|
| Rate for Payer: PHCS Commercial |
$668.16
|
| Rate for Payer: United Healthcare All Payer |
$612.48
|
|
|
DUP-SCAN HEMO COMPL UNI(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
921P0020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$168.21 |
| Rate for Payer: Ambetter Exchange |
$129.39
|
| Rate for Payer: Anthem Medicaid |
$114.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$129.39
|
| Rate for Payer: Buckeye Medicare Advantage |
$129.39
|
| Rate for Payer: CareSource Just4Me Medicare |
$155.27
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Humana Medicaid |
$114.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$35.98
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$129.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$129.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$117.15
|
| Rate for Payer: Molina Healthcare Passport |
$114.85
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.21
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$116.00
|
| Rate for Payer: Wellcare Medicare Advantage |
$129.39
|
|
|
DUP-SCAN HEMO COMPL UNI STD
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
92100018
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.90
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
DUP-SCAN HEMO COMPL UNI STD
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
92100018
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$436.80 |
| Rate for Payer: Aetna Commercial |
$350.35
|
| Rate for Payer: Anthem Medicaid |
$156.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$354.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cash Price |
$227.50
|
| Rate for Payer: Cigna Commercial |
$377.65
|
| Rate for Payer: First Health Commercial |
$432.25
|
| Rate for Payer: Humana Commercial |
$386.75
|
| Rate for Payer: Humana KY Medicaid |
$156.47
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$158.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$373.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$335.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$159.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$400.40
|
| Rate for Payer: Ohio Health Group HMO |
$341.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$395.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$313.95
|
| Rate for Payer: PHCS Commercial |
$436.80
|
| Rate for Payer: United Healthcare All Payer |
$400.40
|
|
|
DUP-SCAN HEMO COMPL UNI(T
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
HCPCS 93986
|
| Hospital Charge Code |
921T0020
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$452.16 |
| Rate for Payer: Aetna Commercial |
$362.67
|
| Rate for Payer: Anthem Medicaid |
$161.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$98.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$367.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$137.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.65
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$390.93
|
| Rate for Payer: First Health Commercial |
$447.45
|
| Rate for Payer: Humana Commercial |
$400.35
|
| Rate for Payer: Humana KY Medicaid |
$161.98
|
| Rate for Payer: Humana Medicare Advantage |
$98.26
|
| Rate for Payer: Kentucky WC Medicaid |
$163.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$386.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$347.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$165.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$414.48
|
| Rate for Payer: Ohio Health Group HMO |
$353.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$324.99
|
| Rate for Payer: PHCS Commercial |
$452.16
|
| Rate for Payer: United Healthcare All Payer |
$414.48
|
|
