|
ANGIOGRAPHY INTERNAL MAMMARY(T
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
320T0162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY(T
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
320T0162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| 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 |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$786.89 |
| Max. Negotiated Rate |
$5,810.88 |
| Rate for Payer: Aetna Commercial |
$4,660.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,721.34
|
| Rate for Payer: Cash Price |
$3,026.50
|
| Rate for Payer: Cigna Commercial |
$5,023.99
|
| Rate for Payer: First Health Commercial |
$5,750.35
|
| Rate for Payer: Humana Commercial |
$5,145.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,963.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,467.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,815.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,326.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,539.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,210.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$786.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,876.43
|
| Rate for Payer: PHCS Commercial |
$5,810.88
|
| Rate for Payer: United Healthcare All Payer |
$5,326.64
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE
|
Professional
|
Both
|
$6,053.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$6,053.00 |
| Rate for Payer: Aetna Commercial |
$444.95
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,053.00
|
| Rate for Payer: Cash Price |
$3,026.50
|
| Rate for Payer: Cash Price |
$3,026.50
|
| Rate for Payer: Cigna Commercial |
$688.88
|
| Rate for Payer: Healthspan PPO |
$416.92
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,631.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,237.10
|
| Rate for Payer: UHCCP Medicaid |
$2,118.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE
|
Facility
|
OP
|
$6,053.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$786.89 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$4,660.81
|
| Rate for Payer: Anthem Medicaid |
$2,081.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,721.34
|
| 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 |
$3,026.50
|
| Rate for Payer: Cash Price |
$3,026.50
|
| Rate for Payer: Cigna Commercial |
$5,023.99
|
| Rate for Payer: First Health Commercial |
$5,750.35
|
| Rate for Payer: Humana Commercial |
$5,145.05
|
| Rate for Payer: Humana KY Medicaid |
$2,081.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,102.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,963.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,467.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,123.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,326.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,539.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,210.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$786.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,876.43
|
| Rate for Payer: PHCS Commercial |
$5,810.88
|
| Rate for Payer: United Healthcare All Payer |
$5,326.64
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE(P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
320P0159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$688.88 |
| Rate for Payer: Aetna Commercial |
$444.95
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$688.88
|
| Rate for Payer: Healthspan PPO |
$416.92
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE(T
|
Facility
|
OP
|
$5,818.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
320T0159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$756.34 |
| Max. Negotiated Rate |
$6,652.97 |
| Rate for Payer: Aetna Commercial |
$4,479.86
|
| Rate for Payer: Anthem Medicaid |
$2,000.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,538.04
|
| 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 |
$2,909.00
|
| Rate for Payer: Cash Price |
$2,909.00
|
| Rate for Payer: Cigna Commercial |
$4,828.94
|
| Rate for Payer: First Health Commercial |
$5,527.10
|
| Rate for Payer: Humana Commercial |
$4,945.30
|
| Rate for Payer: Humana KY Medicaid |
$2,000.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,021.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,770.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,040.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,119.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,163.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,803.58
|
| Rate for Payer: PHCS Commercial |
$5,585.28
|
| Rate for Payer: United Healthcare All Payer |
$5,119.84
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE(T
|
Facility
|
IP
|
$5,818.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
320T0159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$756.34 |
| Max. Negotiated Rate |
$5,585.28 |
| Rate for Payer: Aetna Commercial |
$4,479.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,538.04
|
| Rate for Payer: Cash Price |
$2,909.00
|
| Rate for Payer: Cigna Commercial |
$4,828.94
|
| Rate for Payer: First Health Commercial |
$5,527.10
|
| Rate for Payer: Humana Commercial |
$4,945.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,770.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,293.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,745.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,119.84
|
| Rate for Payer: Ohio Health Group HMO |
$4,363.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,163.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$756.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,803.58
|
| Rate for Payer: PHCS Commercial |
$5,585.28
|
| Rate for Payer: United Healthcare All Payer |
$5,119.84
|
|
|
ANGIOGRAPHY SELECT EA ADD VE(P
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
320P0163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$616.56 |
| Rate for Payer: Aetna Commercial |
$337.66
|
| Rate for Payer: Anthem Medicaid |
$355.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$425.00
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cash Price |
$212.50
|
| Rate for Payer: Cigna Commercial |
$616.56
|
| Rate for Payer: Healthspan PPO |
$316.40
|
| Rate for Payer: Humana Medicaid |
$355.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.80
|
| Rate for Payer: Molina Healthcare Passport |
$355.69
|
| Rate for Payer: Multiplan PHCS |
$255.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$297.50
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$359.25
|
|
|
ANGIOGRAPHY SELECT EA ADD VES
|
Professional
|
Both
|
$3,680.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$3,680.00 |
| Rate for Payer: Aetna Commercial |
$337.66
|
| Rate for Payer: Anthem Medicaid |
$355.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,680.00
|
| Rate for Payer: Cash Price |
$1,840.00
|
| Rate for Payer: Cash Price |
$1,840.00
|
| Rate for Payer: Cigna Commercial |
$616.56
|
| Rate for Payer: Healthspan PPO |
$316.40
|
| Rate for Payer: Humana Medicaid |
$355.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.80
|
| Rate for Payer: Molina Healthcare Passport |
$355.69
|
| Rate for Payer: Multiplan PHCS |
$2,208.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,576.00
|
| Rate for Payer: UHCCP Medicaid |
$1,288.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$359.25
|
|
|
ANGIOGRAPHY SELECT EA ADD VES
|
Facility
|
OP
|
$3,680.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$3,532.80 |
| Rate for Payer: Aetna Commercial |
$2,833.60
|
| Rate for Payer: Anthem Medicaid |
$1,265.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,870.40
|
| Rate for Payer: Cash Price |
$1,840.00
|
| Rate for Payer: Cigna Commercial |
$3,054.40
|
| Rate for Payer: First Health Commercial |
$3,496.00
|
| Rate for Payer: Humana Commercial |
$3,128.00
|
| Rate for Payer: Humana KY Medicaid |
$1,265.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,278.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,017.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,715.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,290.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,238.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,760.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.80
|
| Rate for Payer: PHCS Commercial |
$3,532.80
|
| Rate for Payer: United Healthcare All Payer |
$3,238.40
|
|
|
ANGIOGRAPHY SELECT EA ADD VES
|
Facility
|
IP
|
$3,680.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$3,532.80 |
| Rate for Payer: Aetna Commercial |
$2,833.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,870.40
|
| Rate for Payer: Cash Price |
$1,840.00
|
| Rate for Payer: Cigna Commercial |
$3,054.40
|
| Rate for Payer: First Health Commercial |
$3,496.00
|
| Rate for Payer: Humana Commercial |
$3,128.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,017.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,715.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,238.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,760.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,140.80
|
| Rate for Payer: PHCS Commercial |
$3,532.80
|
| Rate for Payer: United Healthcare All Payer |
$3,238.40
|
|
|
ANGIOGRAPHY SELECT EA ADD VE(T
|
Facility
|
IP
|
$3,255.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
320T0163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.15 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna Commercial |
$2,506.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.90
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cigna Commercial |
$2,701.65
|
| Rate for Payer: First Health Commercial |
$3,092.25
|
| Rate for Payer: Humana Commercial |
$2,766.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,669.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,402.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,441.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$651.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,009.05
|
| Rate for Payer: PHCS Commercial |
$3,124.80
|
| Rate for Payer: United Healthcare All Payer |
$2,864.40
|
|
|
ANGIOGRAPHY SELECT EA ADD VE(T
|
Facility
|
OP
|
$3,255.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
320T0163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.15 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna Commercial |
$2,506.35
|
| Rate for Payer: Anthem Medicaid |
$1,119.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.90
|
| Rate for Payer: Cash Price |
$1,627.50
|
| Rate for Payer: Cigna Commercial |
$2,701.65
|
| Rate for Payer: First Health Commercial |
$3,092.25
|
| Rate for Payer: Humana Commercial |
$2,766.75
|
| Rate for Payer: Humana KY Medicaid |
$1,119.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,130.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,669.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,402.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,141.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,441.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$651.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,009.05
|
| Rate for Payer: PHCS Commercial |
$3,124.80
|
| Rate for Payer: United Healthcare All Payer |
$2,864.40
|
|
|
ANGIOGRAPHY - VISCERAL - SEL
|
Facility
|
IP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,070.55 |
| Max. Negotiated Rate |
$7,905.60 |
| Rate for Payer: Aetna Commercial |
$6,340.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.30
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cigna Commercial |
$6,835.05
|
| Rate for Payer: First Health Commercial |
$7,823.25
|
| Rate for Payer: Humana Commercial |
$6,999.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,470.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,246.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.85
|
| Rate for Payer: PHCS Commercial |
$7,905.60
|
| Rate for Payer: United Healthcare All Payer |
$7,246.80
|
|
|
ANGIOGRAPHY - VISCERAL - SEL
|
Facility
|
OP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,070.55 |
| Max. Negotiated Rate |
$7,905.60 |
| Rate for Payer: Aetna Commercial |
$6,340.95
|
| Rate for Payer: Anthem Medicaid |
$2,832.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.30
|
| 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 |
$4,117.50
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cigna Commercial |
$6,835.05
|
| Rate for Payer: First Health Commercial |
$7,823.25
|
| Rate for Payer: Humana Commercial |
$6,999.75
|
| Rate for Payer: Humana KY Medicaid |
$2,832.02
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,860.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,888.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,246.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,176.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,070.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.85
|
| Rate for Payer: PHCS Commercial |
$7,905.60
|
| Rate for Payer: United Healthcare All Payer |
$7,246.80
|
|
|
ANGIOGRAPHY - VISCERAL - SEL
|
Professional
|
Both
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$8,235.00 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,235.00
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cash Price |
$4,117.50
|
| Rate for Payer: Cigna Commercial |
$685.53
|
| Rate for Payer: Healthspan PPO |
$413.25
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$4,941.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$5,764.50
|
| Rate for Payer: UHCCP Medicaid |
$2,882.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ANGIOGRAPHY - VISCERAL - SEL(P
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320P0158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$685.53 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$335.00
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Cigna Commercial |
$685.53
|
| Rate for Payer: Healthspan PPO |
$413.25
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$73.27
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$201.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$234.50
|
| Rate for Payer: UHCCP Medicaid |
$117.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
|
ANGIOGRAPHY - VISCERAL - SEL(T
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320T0158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,027.00 |
| Max. Negotiated Rate |
$7,584.00 |
| Rate for Payer: Aetna Commercial |
$6,083.00
|
| Rate for Payer: Anthem Medicaid |
$2,716.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| 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 |
$3,950.00
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cigna Commercial |
$6,557.00
|
| Rate for Payer: First Health Commercial |
$7,505.00
|
| Rate for Payer: Humana Commercial |
$6,715.00
|
| Rate for Payer: Humana KY Medicaid |
$2,716.81
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,744.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,830.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,771.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
ANGIOGRAPHY - VISCERAL - SEL(T
|
Facility
|
IP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320T0158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,027.00 |
| Max. Negotiated Rate |
$7,584.00 |
| Rate for Payer: Aetna Commercial |
$6,083.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Cash Price |
$3,950.00
|
| Rate for Payer: Cigna Commercial |
$6,557.00
|
| Rate for Payer: First Health Commercial |
$7,505.00
|
| Rate for Payer: Humana Commercial |
$6,715.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,830.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,370.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,925.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,580.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,449.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
ANGIOJET SOLENT DISTA CATH.
|
Facility
|
IP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ANGIOJET SOLENT DISTA CATH.
|
Facility
|
OP
|
$9,826.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.41 |
| Max. Negotiated Rate |
$9,433.20 |
| Rate for Payer: Aetna Commercial |
$7,566.21
|
| Rate for Payer: Anthem Medicaid |
$3,379.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.48
|
| Rate for Payer: Cash Price |
$4,913.12
|
| Rate for Payer: Cigna Commercial |
$8,155.79
|
| Rate for Payer: First Health Commercial |
$9,334.94
|
| Rate for Payer: Humana Commercial |
$8,352.31
|
| Rate for Payer: Humana KY Medicaid |
$3,379.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,413.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,251.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.10
|
| Rate for Payer: Ohio Health Group HMO |
$7,369.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,046.14
|
| Rate for Payer: PHCS Commercial |
$9,433.20
|
| Rate for Payer: United Healthcare All Payer |
$8,647.10
|
|
|
ANGIOMAX 1MG [250MG VIAL]
|
Facility
|
IP
|
$790.25
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
25001898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.73 |
| Max. Negotiated Rate |
$758.64 |
| Rate for Payer: Aetna Commercial |
$608.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.40
|
| Rate for Payer: Cash Price |
$395.12
|
| Rate for Payer: Cigna Commercial |
$655.91
|
| Rate for Payer: First Health Commercial |
$750.74
|
| Rate for Payer: Humana Commercial |
$671.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.42
|
| Rate for Payer: Ohio Health Group HMO |
$592.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.98
|
| Rate for Payer: PHCS Commercial |
$758.64
|
| Rate for Payer: United Healthcare All Payer |
$695.42
|
|
|
ANGIOMAX 1MG [250MG VIAL]
|
Facility
|
OP
|
$790.25
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
25001898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.73 |
| Max. Negotiated Rate |
$758.64 |
| Rate for Payer: Aetna Commercial |
$608.49
|
| Rate for Payer: Anthem Medicaid |
$271.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.40
|
| Rate for Payer: Cash Price |
$395.12
|
| Rate for Payer: Cigna Commercial |
$655.91
|
| Rate for Payer: First Health Commercial |
$750.74
|
| Rate for Payer: Humana Commercial |
$671.71
|
| Rate for Payer: Humana KY Medicaid |
$271.77
|
| Rate for Payer: Kentucky WC Medicaid |
$274.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$648.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$583.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$277.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$695.42
|
| Rate for Payer: Ohio Health Group HMO |
$592.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$158.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$102.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$244.98
|
| Rate for Payer: PHCS Commercial |
$758.64
|
| Rate for Payer: United Healthcare All Payer |
$695.42
|
|
|
ANGIOMAX KIT 1MG [250MG VIAL]
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
25001899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.64 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$411.84
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$438.24
|
| Rate for Payer: First Health Commercial |
$501.60
|
| Rate for Payer: Humana Commercial |
$448.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$432.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$389.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$158.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$464.64
|
| Rate for Payer: Ohio Health Group HMO |
$396.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$105.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$68.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$163.68
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
| Rate for Payer: Aetna Commercial |
$406.56
|
|
