|
ANES UPR GI NDSC PX ERCP
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 00732
|
| Hospital Charge Code |
37000051
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES UPR GI NDSC PX ERCP
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 732
|
| Hospital Charge Code |
37000051
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES UPR GI NDSC PX ERCP
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 732
|
| Hospital Charge Code |
37000051
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES UPR GI NDSC PX NOS
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 731
|
| Hospital Charge Code |
37000050
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES UPR GI NDSC PX NOS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 731
|
| Hospital Charge Code |
37000050
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES UPR GI NDSC PX NOS
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 00731
|
| Hospital Charge Code |
37000050
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES UPR LWR GI NDSC PX
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 813
|
| Hospital Charge Code |
37000064
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem Medicaid |
$2.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Humana KY Medicaid |
$2.75
|
| Rate for Payer: Kentucky WC Medicaid |
$2.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES UPR LWR GI NDSC PX
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS 00813
|
| Hospital Charge Code |
37000064
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$8.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan PHCS |
$4.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5.60
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
|
|
ANES UPR LWR GI NDSC PX
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS 813
|
| Hospital Charge Code |
37000064
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$7.68 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6.24
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cigna Commercial |
$6.64
|
| Rate for Payer: First Health Commercial |
$7.60
|
| Rate for Payer: Humana Commercial |
$6.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7.04
|
| Rate for Payer: Ohio Health Group HMO |
$6.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2.48
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANGEL CPRP PROCESSING SET
|
Facility
|
IP
|
$3,232.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
ANGEL CPRP PROCESSING SET
|
Facility
|
OP
|
$3,232.50
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
ANGINA PECTORIS
|
Facility
|
IP
|
$8,166.54
|
|
|
Service Code
|
MSDRG 311
|
| Min. Negotiated Rate |
$5,541.58 |
| Max. Negotiated Rate |
$8,166.54 |
| Rate for Payer: Anthem Medicaid |
$5,541.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$5,833.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,166.54
|
| Rate for Payer: CareSource Just4Me Medicare |
$7,874.87
|
| Rate for Payer: Humana KY Medicaid |
$5,541.58
|
| Rate for Payer: Humana Medicare Advantage |
$5,833.24
|
| Rate for Payer: Kentucky WC Medicaid |
$5,596.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,999.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,652.41
|
|
|
ANGIOCATH 14 G X 3.25
|
Facility
|
IP
|
$445.73
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$427.90 |
| Rate for Payer: Aetna Commercial |
$343.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.67
|
| Rate for Payer: Cash Price |
$222.86
|
| Rate for Payer: Cigna Commercial |
$369.96
|
| Rate for Payer: First Health Commercial |
$423.44
|
| Rate for Payer: Humana Commercial |
$378.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.24
|
| Rate for Payer: Ohio Health Group HMO |
$334.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.18
|
| Rate for Payer: PHCS Commercial |
$427.90
|
| Rate for Payer: United Healthcare All Payer |
$392.24
|
|
|
ANGIOCATH 14 G X 3.25
|
Facility
|
OP
|
$445.73
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.94 |
| Max. Negotiated Rate |
$427.90 |
| Rate for Payer: Aetna Commercial |
$343.21
|
| Rate for Payer: Anthem Medicaid |
$153.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$347.67
|
| Rate for Payer: Cash Price |
$222.86
|
| Rate for Payer: Cigna Commercial |
$369.96
|
| Rate for Payer: First Health Commercial |
$423.44
|
| Rate for Payer: Humana Commercial |
$378.87
|
| Rate for Payer: Humana KY Medicaid |
$153.29
|
| Rate for Payer: Kentucky WC Medicaid |
$154.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$365.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$328.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$133.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$156.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$392.24
|
| Rate for Payer: Ohio Health Group HMO |
$334.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$89.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$138.18
|
| Rate for Payer: PHCS Commercial |
$427.90
|
| Rate for Payer: United Healthcare All Payer |
$392.24
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
OP
|
$4,775.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.75 |
| Max. Negotiated Rate |
$4,584.00 |
| Rate for Payer: Aetna Commercial |
$3,676.75
|
| Rate for Payer: Anthem Medicaid |
$1,642.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,724.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,387.50
|
| Rate for Payer: Cash Price |
$2,387.50
|
| Rate for Payer: Cigna Commercial |
$3,963.25
|
| Rate for Payer: First Health Commercial |
$4,536.25
|
| Rate for Payer: Humana Commercial |
$4,058.75
|
| Rate for Payer: Humana KY Medicaid |
$1,642.12
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,658.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,915.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,523.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.25
|
| Rate for Payer: PHCS Commercial |
$4,584.00
|
| Rate for Payer: United Healthcare All Payer |
$4,202.00
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
320T0156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Professional
|
Both
|
$4,775.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$4,775.00 |
| Rate for Payer: Aetna Commercial |
$446.20
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,775.00
|
| Rate for Payer: Cash Price |
$2,387.50
|
| Rate for Payer: Cash Price |
$2,387.50
|
| Rate for Payer: Cigna Commercial |
$692.73
|
| Rate for Payer: Healthspan PPO |
$418.10
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.68
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,865.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,342.50
|
| Rate for Payer: UHCCP Medicaid |
$1,671.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
320T0156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem Medicaid |
$1,573.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Humana KY Medicaid |
$1,573.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
320P0156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$692.73 |
| Rate for Payer: Aetna Commercial |
$446.20
|
| 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 |
$692.73
|
| Rate for Payer: Healthspan PPO |
$418.10
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$71.68
|
| 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
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
IP
|
$4,775.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.75 |
| Max. Negotiated Rate |
$4,584.00 |
| Rate for Payer: Aetna Commercial |
$3,676.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,724.50
|
| Rate for Payer: Cash Price |
$2,387.50
|
| Rate for Payer: Cigna Commercial |
$3,963.25
|
| Rate for Payer: First Health Commercial |
$4,536.25
|
| Rate for Payer: Humana Commercial |
$4,058.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,915.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,523.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,581.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.25
|
| Rate for Payer: PHCS Commercial |
$4,584.00
|
| Rate for Payer: United Healthcare All Payer |
$4,202.00
|
|
|
ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$3,858.95
|
|
|
Service Code
|
CPT 75710
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,756.39 |
| Max. Negotiated Rate |
$3,858.95 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY
|
Facility
|
IP
|
$5,367.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$697.71 |
| Max. Negotiated Rate |
$5,152.32 |
| Rate for Payer: Aetna Commercial |
$4,132.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,186.26
|
| Rate for Payer: Cash Price |
$2,683.50
|
| Rate for Payer: Cigna Commercial |
$4,454.61
|
| Rate for Payer: First Health Commercial |
$5,098.65
|
| Rate for Payer: Humana Commercial |
$4,561.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,025.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,663.77
|
| Rate for Payer: PHCS Commercial |
$5,152.32
|
| Rate for Payer: United Healthcare All Payer |
$4,722.96
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY
|
Professional
|
Both
|
$5,367.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.67 |
| Max. Negotiated Rate |
$5,367.00 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,367.00
|
| Rate for Payer: Cash Price |
$2,683.50
|
| Rate for Payer: Cash Price |
$2,683.50
|
| Rate for Payer: Cigna Commercial |
$699.87
|
| Rate for Payer: Healthspan PPO |
$427.62
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,220.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,756.90
|
| Rate for Payer: UHCCP Medicaid |
$1,878.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY
|
Facility
|
OP
|
$5,367.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$697.71 |
| Max. Negotiated Rate |
$5,152.32 |
| Rate for Payer: Aetna Commercial |
$4,132.59
|
| Rate for Payer: Anthem Medicaid |
$1,845.71
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,186.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,683.50
|
| Rate for Payer: Cash Price |
$2,683.50
|
| Rate for Payer: Cigna Commercial |
$4,454.61
|
| Rate for Payer: First Health Commercial |
$5,098.65
|
| Rate for Payer: Humana Commercial |
$4,561.95
|
| Rate for Payer: Humana KY Medicaid |
$1,845.71
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,864.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,400.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,960.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,882.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,722.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,025.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,073.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$697.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,663.77
|
| Rate for Payer: PHCS Commercial |
$5,152.32
|
| Rate for Payer: United Healthcare All Payer |
$4,722.96
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY(P
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
320P0162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.67 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$900.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna Commercial |
$699.87
|
| Rate for Payer: Healthspan PPO |
$427.62
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$83.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$540.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$630.00
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
