|
IMAGE CATH FLUID COLXN VISC(P
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
761P1996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.26 |
| Max. Negotiated Rate |
$1,123.62 |
| Rate for Payer: Ambetter Exchange |
$181.65
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$165.26
|
| Rate for Payer: Anthem Medicaid |
$655.14
|
| Rate for Payer: Buckeye Individual/Medicaid |
$181.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$181.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$217.98
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$355.29
|
| Rate for Payer: Healthspan PPO |
$1,123.62
|
| Rate for Payer: Humana Medicaid |
$655.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$277.78
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$181.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$181.65
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$668.24
|
| Rate for Payer: Molina Healthcare Passport |
$655.14
|
| Rate for Payer: Multiplan PHCS |
$360.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$236.15
|
| Rate for Payer: UHCCP Medicaid |
$173.52
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$661.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$181.65
|
|
|
IMAGE CATH FLUID COLXN VISC(T
|
Facility
|
OP
|
$3,823.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
761T1996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,314.73 |
| Max. Negotiated Rate |
$3,670.08 |
| Rate for Payer: Aetna Commercial |
$2,943.71
|
| Rate for Payer: Anthem Medicaid |
$1,314.73
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,497.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,981.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,095.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,021.04
|
| Rate for Payer: Cash Price |
$1,911.50
|
| Rate for Payer: Cash Price |
$1,911.50
|
| Rate for Payer: Cigna Commercial |
$3,173.09
|
| Rate for Payer: First Health Commercial |
$3,631.85
|
| Rate for Payer: Humana Commercial |
$3,249.55
|
| Rate for Payer: Humana KY Medicaid |
$1,314.73
|
| Rate for Payer: Humana Medicare Advantage |
$1,497.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,328.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,134.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,821.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,796.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,341.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,364.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,867.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,058.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,326.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,637.87
|
| Rate for Payer: PHCS Commercial |
$3,670.08
|
| Rate for Payer: United Healthcare All Payer |
$3,364.24
|
|
|
IMAGE CATH FLUID COLXN VISC(T
|
Facility
|
IP
|
$3,823.00
|
|
|
Service Code
|
HCPCS 49405
|
| Hospital Charge Code |
761T1996
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,146.90 |
| Max. Negotiated Rate |
$3,670.08 |
| Rate for Payer: Aetna Commercial |
$2,943.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,981.94
|
| Rate for Payer: Cash Price |
$1,911.50
|
| Rate for Payer: Cigna Commercial |
$3,173.09
|
| Rate for Payer: First Health Commercial |
$3,631.85
|
| Rate for Payer: Humana Commercial |
$3,249.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,134.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,821.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,146.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,364.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,867.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,058.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,326.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,637.87
|
| Rate for Payer: PHCS Commercial |
$3,670.08
|
| Rate for Payer: United Healthcare All Payer |
$3,364.24
|
|
|
IMAGING CORONARY INJECT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
47000037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$134.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| 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: 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 |
$52.50
|
| 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 |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| Rate for Payer: PHCS Commercial |
$168.00
|
| Rate for Payer: United Healthcare All Payer |
$154.00
|
|
|
IMAGING CORONARY INJECT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
47000037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Ambetter Exchange |
$41.59
|
| Rate for Payer: Anthem Medicaid |
$15.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.91
|
| Rate for Payer: Cash Price |
$87.50
|
| Rate for Payer: Cash Price |
$87.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$41.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$16.26
|
| Rate for Payer: Molina Healthcare Passport |
$15.94
|
| Rate for Payer: Multiplan PHCS |
$105.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$54.07
|
| Rate for Payer: UHCCP Medicaid |
$61.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.59
|
|
|
IMAGING CORONARY INJECT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
47000037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$54.88 |
| 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 |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$136.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$152.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$120.75
|
| 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 |
$54.07 |
| Rate for Payer: Aetna Commercial |
$37.46
|
| Rate for Payer: Ambetter Exchange |
$41.59
|
| Rate for Payer: Anthem Medicaid |
$15.94
|
| Rate for Payer: Buckeye Individual/Medicaid |
$41.59
|
| Rate for Payer: Buckeye Medicare Advantage |
$41.59
|
| Rate for Payer: CareSource Just4Me Medicare |
$49.91
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$41.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$41.59
|
| 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 |
$54.07
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$16.10
|
| Rate for Payer: Wellcare Medicare Advantage |
$41.59
|
|
|
IMAGING CORONARY INJECT(T
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
470T0037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$42.99 |
| 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 |
$54.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$97.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$76.83
|
| Rate for Payer: CareSource Just4Me Medicare |
$74.09
|
| 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 |
$54.88
|
| 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 |
$65.86
|
| 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 |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
IMAGING CORONARY INJECT(T
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
HCPCS 92556
|
| Hospital Charge Code |
470T0037
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$37.50 |
| 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 |
$100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$86.25
|
| Rate for Payer: PHCS Commercial |
$120.00
|
| Rate for Payer: United Healthcare All Payer |
$110.00
|
|
|
IMAGING PSEUDOANEURYSM
|
Facility
|
OP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem Medicaid |
$507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Humana KY Medicaid |
$507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$512.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$517.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
IMAGING PSEUDOANEURYSM
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$42.85 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Aetna Commercial |
$278.08
|
| Rate for Payer: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cash Price |
$737.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$71.92
|
| Rate for Payer: Molina Healthcare Passport |
$70.51
|
| Rate for Payer: Multiplan PHCS |
$885.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$516.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
IMAGING PSEUDOANEURYSM
|
Facility
|
IP
|
$1,475.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
40200082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$1,135.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,150.50
|
| Rate for Payer: Cash Price |
$737.50
|
| Rate for Payer: Cigna Commercial |
$1,224.25
|
| Rate for Payer: First Health Commercial |
$1,401.25
|
| Rate for Payer: Humana Commercial |
$1,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,209.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,088.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$442.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,298.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,106.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,283.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.75
|
| Rate for Payer: PHCS Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare All Payer |
$1,298.00
|
|
|
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: Ambetter Exchange |
$54.24
|
| Rate for Payer: Anthem Medicaid |
$70.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$54.24
|
| Rate for Payer: Buckeye Medicare Advantage |
$54.24
|
| Rate for Payer: CareSource Just4Me Medicare |
$65.09
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$54.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$54.24
|
| 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 |
$70.51
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$71.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$54.24
|
|
|
IMAGING PSEUDOANEURYSM(T
|
Facility
|
IP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
IMAGING PSEUDOANEURYSM(T
|
Facility
|
OP
|
$1,275.00
|
|
|
Service Code
|
HCPCS 76942
|
| Hospital Charge Code |
402T0082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Anthem Medicaid |
$438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$994.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,058.25
|
| Rate for Payer: First Health Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial |
$1,083.75
|
| Rate for Payer: Humana KY Medicaid |
$438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$442.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,045.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$940.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$382.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$447.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,122.00
|
| Rate for Payer: Ohio Health Group HMO |
$956.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,109.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$879.75
|
| Rate for Payer: PHCS Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare All Payer |
$1,122.00
|
|
|
IMAGING S & I THORACIC AO
|
Facility
|
IP
|
$6,523.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
32000152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,956.90 |
| Max. Negotiated Rate |
$6,262.08 |
| Rate for Payer: Aetna Commercial |
$5,022.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,087.94
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$5,414.09
|
| Rate for Payer: First Health Commercial |
$6,196.85
|
| Rate for Payer: Humana Commercial |
$5,544.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,348.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,813.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,956.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,740.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,675.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,500.87
|
| Rate for Payer: PHCS Commercial |
$6,262.08
|
| Rate for Payer: United Healthcare All Payer |
$5,740.24
|
|
|
IMAGING S & I THORACIC AO
|
Facility
|
OP
|
$6,523.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
32000152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,243.26 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$5,022.71
|
| Rate for Payer: Anthem Medicaid |
$2,243.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,087.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cigna Commercial |
$5,414.09
|
| Rate for Payer: First Health Commercial |
$6,196.85
|
| Rate for Payer: Humana Commercial |
$5,544.55
|
| Rate for Payer: Humana KY Medicaid |
$2,243.26
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,266.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,348.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,813.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,288.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,740.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,892.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,675.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,500.87
|
| Rate for Payer: PHCS Commercial |
$6,262.08
|
| Rate for Payer: United Healthcare All Payer |
$5,740.24
|
|
|
IMAGING S & I THORACIC AO
|
Professional
|
Both
|
$6,523.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
32000152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$3,913.80 |
| Rate for Payer: Aetna Commercial |
$428.17
|
| Rate for Payer: Ambetter Exchange |
$110.21
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.25
|
| Rate for Payer: Cash Price |
$3,261.50
|
| Rate for Payer: Cash Price |
$3,261.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$110.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.21
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,913.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$143.27
|
| Rate for Payer: UHCCP Medicaid |
$2,283.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.21
|
|
|
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: Ambetter Exchange |
$110.21
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$110.21
|
| Rate for Payer: Buckeye Medicare Advantage |
$110.21
|
| Rate for Payer: CareSource Just4Me Medicare |
$132.25
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$110.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$110.21
|
| 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 |
$143.27
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$110.21
|
|
|
IMAGING S & I THORACIC AO(T
|
Facility
|
OP
|
$6,323.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
320T0152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,174.48 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$4,868.71
|
| Rate for Payer: Anthem Medicaid |
$2,174.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,931.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$3,161.50
|
| Rate for Payer: Cash Price |
$3,161.50
|
| Rate for Payer: Cigna Commercial |
$5,248.09
|
| Rate for Payer: First Health Commercial |
$6,006.85
|
| Rate for Payer: Humana Commercial |
$5,374.55
|
| Rate for Payer: Humana KY Medicaid |
$2,174.48
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,196.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,184.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,666.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,218.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,564.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,742.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,058.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,501.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.87
|
| Rate for Payer: PHCS Commercial |
$6,070.08
|
| Rate for Payer: United Healthcare All Payer |
$5,564.24
|
|
|
IMAGING S & I THORACIC AO(T
|
Facility
|
IP
|
$6,323.00
|
|
|
Service Code
|
HCPCS 75605
|
| Hospital Charge Code |
320T0152
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,896.90 |
| Max. Negotiated Rate |
$6,070.08 |
| Rate for Payer: Aetna Commercial |
$4,868.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,931.94
|
| Rate for Payer: Cash Price |
$3,161.50
|
| Rate for Payer: Cigna Commercial |
$5,248.09
|
| Rate for Payer: First Health Commercial |
$6,006.85
|
| Rate for Payer: Humana Commercial |
$5,374.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,184.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,666.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,896.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,564.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,742.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,058.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,501.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,362.87
|
| Rate for Payer: PHCS Commercial |
$6,070.08
|
| Rate for Payer: United Healthcare All Payer |
$5,564.24
|
|
|
IMDUR (ISOSORB MONON 30MG/1TAB
|
Facility
|
OP
|
$4.26
|
|
|
Service Code
|
NDC 50742017505
|
| Hospital Charge Code |
25000770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem Medicaid |
$1.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Humana KY Medicaid |
$1.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
IMDUR (ISOSORB MONON 30MG/1TAB
|
Facility
|
IP
|
$4.26
|
|
|
Service Code
|
NDC 50742017505
|
| Hospital Charge Code |
25000770
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.32
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cigna Commercial |
$3.54
|
| Rate for Payer: First Health Commercial |
$4.05
|
| Rate for Payer: Humana Commercial |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.75
|
| Rate for Payer: Ohio Health Group HMO |
$3.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.94
|
| Rate for Payer: PHCS Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Payer |
$3.75
|
|
|
IMDUR(ISOSORB MONONI 60MG/1TAB
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 904645061
|
| Hospital Charge Code |
25000771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| 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 |
$3.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| 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 |
$1.38 |
| 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 |
$3.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.18
|
| Rate for Payer: PHCS Commercial |
$4.43
|
| Rate for Payer: United Healthcare All Payer |
$4.06
|
|
