|
IMAGING CORONARY INJECT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
47000037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem Medicaid |
$60.18
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cigna Commercial |
$145.25
|
| Rate for Payer: First Health Commercial |
$166.25
|
| Rate for Payer: Humana Commercial |
$148.75
|
| Rate for Payer: Humana KY Medicaid |
$60.18
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$60.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$143.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$129.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$154.00
|
| Rate for Payer: Ohio Health Group HMO |
$131.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$54.25
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
IMAGING CORONARY INJECT(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
470P0037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Anthem Medicaid |
$15.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$35.59
|
| Rate for Payer: Healthspan PPO |
$30.64
|
| Rate for Payer: Humana Medicaid |
$15.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$32.77
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.26
|
| Rate for Payer: Molina Healthcare Passport |
$15.94
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.10
|
|
|
IMAGING CORONARY INJECT(T
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
470T0037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$37.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
IMAGING CORONARY INJECT(T
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
470T0037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Anthem Medicaid |
$42.99
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$52.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$74.05
|
| Rate for Payer: CareSource Just4Me Medicare |
$71.40
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cigna Commercial |
$103.75
|
| Rate for Payer: First Health Commercial |
$118.75
|
| Rate for Payer: Humana Commercial |
$106.25
|
| Rate for Payer: Humana KY Medicaid |
$42.99
|
| Rate for Payer: Humana Medicare Advantage |
$52.89
|
| Rate for Payer: Kentucky WC Medicaid |
$43.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$102.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$92.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$63.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$43.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$110.00
|
| Rate for Payer: Ohio Health Group HMO |
$93.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$38.75
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
IMAGING PSEUDOANEURYSM
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,397.00
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$838.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$977.90
|
| Rate for Payer: UHCCP Medicaid |
$488.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
IMAGING PSEUDOANEURYSM
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
IMAGING PSEUDOANEURYSM
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.61 |
| Max. Negotiated Rate |
$1,341.12 |
| Rate for Payer: Aetna Commercial |
$1,075.69
|
| Rate for Payer: Anthem Medicaid |
$480.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,089.66
|
| Rate for Payer: Cash Price |
$698.50
|
| Rate for Payer: Cigna Commercial |
$1,159.51
|
| Rate for Payer: First Health Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial |
$1,187.45
|
| Rate for Payer: Humana KY Medicaid |
$480.43
|
| Rate for Payer: Kentucky WC Medicaid |
$485.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,145.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,030.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$419.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$490.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,229.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,047.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$181.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$433.07
|
| Rate for Payer: PHCS Commercial |
$1,341.12
|
| Rate for Payer: United Healthcare All Payer |
$1,229.36
|
|
|
IMAGING PSEUDOANEURYSM(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402P0082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$244.99
|
| Rate for Payer: Healthspan PPO |
$260.56
|
| Rate for Payer: Humana Medicaid |
$70.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$42.85
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
|
|
IMAGING PSEUDOANEURYSM(T
|
Facility
|
OP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem Medicaid |
$411.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Humana KY Medicaid |
$411.65
|
| Rate for Payer: Kentucky WC Medicaid |
$415.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
IMAGING PSEUDOANEURYSM(T
|
Facility
|
IP
|
$1,197.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$921.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$933.66
|
| Rate for Payer: Cash Price |
$598.50
|
| Rate for Payer: Cigna Commercial |
$993.51
|
| Rate for Payer: First Health Commercial |
$1,137.15
|
| Rate for Payer: Humana Commercial |
$1,017.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$981.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$883.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,053.36
|
| Rate for Payer: Ohio Health Group HMO |
$897.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$239.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$155.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$371.07
|
| Rate for Payer: PHCS Commercial |
$1,149.12
|
| Rate for Payer: United Healthcare All Payer |
$1,053.36
|
|
|
IMAGING S & I THORACIC AO
|
Professional
|
Both
|
$6,137.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
32000152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$6,137.00 |
| Rate for Payer: Aetna Commercial |
$428.17
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,137.00
|
| Rate for Payer: Cash Price |
$3,068.50
|
| Rate for Payer: Cash Price |
$3,068.50
|
| Rate for Payer: Cigna Commercial |
$686.65
|
| Rate for Payer: Healthspan PPO |
$401.20
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,682.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,295.90
|
| Rate for Payer: UHCCP Medicaid |
$2,147.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
IMAGING S & I THORACIC AO
|
Facility
|
OP
|
$6,137.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
32000152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$797.81 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$4,725.49
|
| Rate for Payer: Anthem Medicaid |
$2,110.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,786.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$3,068.50
|
| Rate for Payer: Cash Price |
$3,068.50
|
| Rate for Payer: Cigna Commercial |
$5,093.71
|
| Rate for Payer: First Health Commercial |
$5,830.15
|
| Rate for Payer: Humana Commercial |
$5,216.45
|
| Rate for Payer: Humana KY Medicaid |
$2,110.51
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,131.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,032.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,529.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,152.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,400.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,602.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,227.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$797.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,902.47
|
| Rate for Payer: PHCS Commercial |
$5,891.52
|
| Rate for Payer: United Healthcare All Payer |
$5,400.56
|
|
|
IMAGING S & I THORACIC AO
|
Facility
|
IP
|
$6,137.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
32000152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$797.81 |
| Max. Negotiated Rate |
$5,891.52 |
| Rate for Payer: Aetna Commercial |
$4,725.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,786.86
|
| Rate for Payer: Cash Price |
$3,068.50
|
| Rate for Payer: Cigna Commercial |
$5,093.71
|
| Rate for Payer: First Health Commercial |
$5,830.15
|
| Rate for Payer: Humana Commercial |
$5,216.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,032.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,529.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,841.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,400.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,602.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,227.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$797.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,902.47
|
| Rate for Payer: PHCS Commercial |
$5,891.52
|
| Rate for Payer: United Healthcare All Payer |
$5,400.56
|
|
|
IMAGING S & I THORACIC AO(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
320P0152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$686.65 |
| Rate for Payer: Aetna Commercial |
$428.17
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$686.65
|
| Rate for Payer: Healthspan PPO |
$401.20
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
IMAGING S & I THORACIC AO(T
|
Facility
|
IP
|
$5,937.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
320T0152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$771.81 |
| Max. Negotiated Rate |
$5,699.52 |
| Rate for Payer: Aetna Commercial |
$4,571.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,630.86
|
| Rate for Payer: Cash Price |
$2,968.50
|
| Rate for Payer: Cigna Commercial |
$4,927.71
|
| Rate for Payer: First Health Commercial |
$5,640.15
|
| Rate for Payer: Humana Commercial |
$5,046.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,868.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,381.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,781.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,224.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,452.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,187.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,840.47
|
| Rate for Payer: PHCS Commercial |
$5,699.52
|
| Rate for Payer: United Healthcare All Payer |
$5,224.56
|
|
|
IMAGING S & I THORACIC AO(T
|
Facility
|
OP
|
$5,937.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
320T0152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$771.81 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$4,571.49
|
| Rate for Payer: Anthem Medicaid |
$2,041.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,630.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$2,968.50
|
| Rate for Payer: Cash Price |
$2,968.50
|
| Rate for Payer: Cigna Commercial |
$4,927.71
|
| Rate for Payer: First Health Commercial |
$5,640.15
|
| Rate for Payer: Humana Commercial |
$5,046.45
|
| Rate for Payer: Humana KY Medicaid |
$2,041.73
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,062.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,868.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,381.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,082.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,224.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,452.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,187.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$771.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,840.47
|
| Rate for Payer: PHCS Commercial |
$5,699.52
|
| Rate for Payer: United Healthcare All Payer |
$5,224.56
|
|
|
IMDUR (ISOSORB MONON 30MG/1TAB
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 50742017505
|
| Hospital Charge Code |
25000770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
IMDUR (ISOSORB MONON 30MG/1TAB
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 50742017505
|
| Hospital Charge Code |
25000770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Anthem Medicaid |
$1.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.37
|
| Rate for Payer: Cash Price |
$2.16
|
| Rate for Payer: Cigna Commercial |
$3.59
|
| Rate for Payer: First Health Commercial |
$4.10
|
| Rate for Payer: Humana Commercial |
$3.67
|
| Rate for Payer: Humana KY Medicaid |
$1.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.80
|
| Rate for Payer: Ohio Health Group HMO |
$3.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.34
|
| Rate for Payer: PHCS Commercial |
$4.15
|
| Rate for Payer: United Healthcare All Payer |
$3.80
|
|
|
IMDUR(ISOSORB MONONI 60MG/1TAB
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 904645061
|
| Hospital Charge Code |
25000771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
IMDUR(ISOSORB MONONI 60MG/1TAB
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 904645061
|
| Hospital Charge Code |
25000771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Anthem Medicaid |
$1.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.60
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: First Health Commercial |
$4.38
|
| Rate for Payer: Humana Commercial |
$3.92
|
| Rate for Payer: Humana KY Medicaid |
$1.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4.06
|
| Rate for Payer: Ohio Health Group HMO |
$3.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.43
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
|
IMFINZI 10MG (120MG VIAL)
|
Facility
|
IP
|
$5,399.32
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
25002607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$701.91 |
| Max. Negotiated Rate |
$5,183.35 |
| Rate for Payer: Aetna Commercial |
$4,157.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.47
|
| Rate for Payer: Cash Price |
$2,699.66
|
| Rate for Payer: Cigna Commercial |
$4,481.44
|
| Rate for Payer: First Health Commercial |
$5,129.35
|
| Rate for Payer: Humana Commercial |
$4,589.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.79
|
| Rate for Payer: PHCS Commercial |
$5,183.35
|
| Rate for Payer: United Healthcare All Payer |
$4,751.40
|
|
|
IMFINZI 10MG (120MG VIAL)
|
Facility
|
OP
|
$5,399.32
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
25002607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$5,183.35 |
| Rate for Payer: Aetna Commercial |
$4,157.48
|
| Rate for Payer: Anthem Medicaid |
$1,856.83
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$80.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.47
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$112.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.95
|
| Rate for Payer: Cash Price |
$2,699.66
|
| Rate for Payer: Cash Price |
$2,699.66
|
| Rate for Payer: Cigna Commercial |
$4,481.44
|
| Rate for Payer: First Health Commercial |
$5,129.35
|
| Rate for Payer: Humana Commercial |
$4,589.42
|
| Rate for Payer: Humana KY Medicaid |
$1,856.83
|
| Rate for Payer: Humana Medicare Advantage |
$80.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,894.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.79
|
| Rate for Payer: PHCS Commercial |
$5,183.35
|
| Rate for Payer: United Healthcare All Payer |
$4,751.40
|
|
|
IMFINZI 10MG (500MG VL)
|
Facility
|
OP
|
$22,497.06
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
25003911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.71 |
| Max. Negotiated Rate |
$21,597.18 |
| Rate for Payer: Aetna Commercial |
$17,322.74
|
| Rate for Payer: Anthem Medicaid |
$7,736.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$80.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,547.71
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$112.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$108.95
|
| Rate for Payer: Cash Price |
$11,248.53
|
| Rate for Payer: Cash Price |
$11,248.53
|
| Rate for Payer: Cigna Commercial |
$18,672.56
|
| Rate for Payer: First Health Commercial |
$21,372.21
|
| Rate for Payer: Humana Commercial |
$19,122.50
|
| Rate for Payer: Humana KY Medicaid |
$7,736.74
|
| Rate for Payer: Humana Medicare Advantage |
$80.71
|
| Rate for Payer: Kentucky WC Medicaid |
$7,815.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,447.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,891.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,797.41
|
| Rate for Payer: Ohio Health Group HMO |
$16,872.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.09
|
| Rate for Payer: PHCS Commercial |
$21,597.18
|
| Rate for Payer: United Healthcare All Payer |
$19,797.41
|
|
|
IMFINZI 10MG (500MG VL)
|
Facility
|
IP
|
$22,497.06
|
|
|
Service Code
|
HCPCS J9173
|
| Hospital Charge Code |
25003911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,924.62 |
| Max. Negotiated Rate |
$21,597.18 |
| Rate for Payer: Aetna Commercial |
$17,322.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,547.71
|
| Rate for Payer: Cash Price |
$11,248.53
|
| Rate for Payer: Cigna Commercial |
$18,672.56
|
| Rate for Payer: First Health Commercial |
$21,372.21
|
| Rate for Payer: Humana Commercial |
$19,122.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,447.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,602.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,749.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,797.41
|
| Rate for Payer: Ohio Health Group HMO |
$16,872.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,499.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,924.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,974.09
|
| Rate for Payer: PHCS Commercial |
$21,597.18
|
| Rate for Payer: United Healthcare All Payer |
$19,797.41
|
|
|
IM GUIDE 8FR
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
