|
ANES UPR GI NDSC PX NOS
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS 00731
|
| Hospital Charge Code |
37000050
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| 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 |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| 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 00731
|
| Hospital Charge Code |
37000050
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| 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 |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| 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 731
|
| Hospital Charge Code |
37000050
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| 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 00813
|
| Hospital Charge Code |
37000064
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| 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 |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| 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 813
|
| Hospital Charge Code |
37000064
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.60 |
| 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 00813
|
| Hospital Charge Code |
37000064
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$2.40 |
| 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 |
$6.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5.52
|
| Rate for Payer: PHCS Commercial |
$7.68
|
| Rate for Payer: United Healthcare All Payer |
$7.04
|
|
|
ANES URGENT HYSTERECTOMY
|
Professional
|
Both
|
$2.50
|
|
|
Service Code
|
HCPCS 1962
|
| Hospital Charge Code |
37000273
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Multiplan PHCS |
$1.50
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1.75
|
| Rate for Payer: UHCCP Medicaid |
$0.88
|
|
|
ANGEL CPRP PROCESSING SET
|
Facility
|
IP
|
$3,106.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
ANGEL CPRP PROCESSING SET
|
Facility
|
OP
|
$3,106.25
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem Medicaid |
$1,068.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Humana KY Medicaid |
$1,068.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,079.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
ANGIOCATH 14 G X 3.25
|
Facility
|
IP
|
$448.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$430.89 |
| Rate for Payer: Aetna Commercial |
$345.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.10
|
| Rate for Payer: Cash Price |
$224.42
|
| Rate for Payer: Cigna Commercial |
$372.54
|
| Rate for Payer: First Health Commercial |
$426.40
|
| Rate for Payer: Humana Commercial |
$381.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.98
|
| Rate for Payer: Ohio Health Group HMO |
$336.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.70
|
| Rate for Payer: PHCS Commercial |
$430.89
|
| Rate for Payer: United Healthcare All Payer |
$394.98
|
|
|
ANGIOCATH 14 G X 3.25
|
Facility
|
OP
|
$448.84
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.65 |
| Max. Negotiated Rate |
$430.89 |
| Rate for Payer: Aetna Commercial |
$345.61
|
| Rate for Payer: Anthem Medicaid |
$154.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$350.10
|
| Rate for Payer: Cash Price |
$224.42
|
| Rate for Payer: Cigna Commercial |
$372.54
|
| Rate for Payer: First Health Commercial |
$426.40
|
| Rate for Payer: Humana Commercial |
$381.51
|
| Rate for Payer: Humana KY Medicaid |
$154.36
|
| Rate for Payer: Kentucky WC Medicaid |
$155.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$368.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$331.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$134.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$157.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$394.98
|
| Rate for Payer: Ohio Health Group HMO |
$336.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$390.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$309.70
|
| Rate for Payer: PHCS Commercial |
$430.89
|
| Rate for Payer: United Healthcare All Payer |
$394.98
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
IP
|
$5,072.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,521.60 |
| Max. Negotiated Rate |
$4,869.12 |
| Rate for Payer: Aetna Commercial |
$3,905.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,956.16
|
| Rate for Payer: Cash Price |
$2,536.00
|
| Rate for Payer: Cigna Commercial |
$4,209.76
|
| Rate for Payer: First Health Commercial |
$4,818.40
|
| Rate for Payer: Humana Commercial |
$4,311.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,159.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,743.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,463.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,804.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,412.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.68
|
| Rate for Payer: PHCS Commercial |
$4,869.12
|
| Rate for Payer: United Healthcare All Payer |
$4,463.36
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
OP
|
$5,072.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,744.26 |
| Max. Negotiated Rate |
$4,869.12 |
| Rate for Payer: Aetna Commercial |
$3,905.44
|
| Rate for Payer: Anthem Medicaid |
$1,744.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,956.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,536.00
|
| Rate for Payer: Cash Price |
$2,536.00
|
| Rate for Payer: Cigna Commercial |
$4,209.76
|
| Rate for Payer: First Health Commercial |
$4,818.40
|
| Rate for Payer: Humana Commercial |
$4,311.20
|
| Rate for Payer: Humana KY Medicaid |
$1,744.26
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,762.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,159.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,743.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,779.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,463.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,804.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,412.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.68
|
| Rate for Payer: PHCS Commercial |
$4,869.12
|
| Rate for Payer: United Healthcare All Payer |
$4,463.36
|
|
|
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: Ambetter Exchange |
$136.82
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.18
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$136.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.82
|
| 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 |
$177.87
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.82
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Professional
|
Both
|
$5,072.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$3,043.20 |
| Rate for Payer: Aetna Commercial |
$446.20
|
| Rate for Payer: Ambetter Exchange |
$136.82
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$136.82
|
| Rate for Payer: Buckeye Medicare Advantage |
$136.82
|
| Rate for Payer: CareSource Just4Me Medicare |
$164.18
|
| Rate for Payer: Cash Price |
$2,536.00
|
| Rate for Payer: Cash Price |
$2,536.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$136.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$136.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,043.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$177.87
|
| Rate for Payer: UHCCP Medicaid |
$1,775.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$136.82
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
IP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
320T0156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,461.60 |
| Max. Negotiated Rate |
$4,677.12 |
| Rate for Payer: Aetna Commercial |
$3,751.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,800.16
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$4,043.76
|
| Rate for Payer: First Health Commercial |
$4,628.40
|
| Rate for Payer: Humana Commercial |
$4,141.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,995.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,595.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,461.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,287.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,238.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,361.68
|
| Rate for Payer: PHCS Commercial |
$4,677.12
|
| Rate for Payer: United Healthcare All Payer |
$4,287.36
|
|
|
ANGIOGRAPHY EXTREMITY UNILATER
|
Facility
|
OP
|
$4,872.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
320T0156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,675.48 |
| Max. Negotiated Rate |
$4,677.12 |
| Rate for Payer: Aetna Commercial |
$3,751.44
|
| Rate for Payer: Anthem Medicaid |
$1,675.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,800.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cash Price |
$2,436.00
|
| Rate for Payer: Cigna Commercial |
$4,043.76
|
| Rate for Payer: First Health Commercial |
$4,628.40
|
| Rate for Payer: Humana Commercial |
$4,141.20
|
| Rate for Payer: Humana KY Medicaid |
$1,675.48
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,692.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,995.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,595.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,709.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,287.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,654.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,897.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,238.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,361.68
|
| Rate for Payer: PHCS Commercial |
$4,677.12
|
| Rate for Payer: United Healthcare All Payer |
$4,287.36
|
|
|
ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 75710
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY
|
Facility
|
IP
|
$5,367.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,610.10 |
| 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 |
$4,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,669.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,703.23
|
| Rate for Payer: PHCS Commercial |
$5,152.32
|
| Rate for Payer: United Healthcare All Payer |
$4,722.96
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY
|
Facility
|
OP
|
$5,367.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
32000162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,845.71 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,186.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$4,293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,669.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,703.23
|
| 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 |
$3,220.20 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Ambetter Exchange |
$147.38
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$147.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.38
|
| 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 |
$191.59
|
| Rate for Payer: UHCCP Medicaid |
$1,878.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.38
|
|
|
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 |
$699.87 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Ambetter Exchange |
$147.38
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$147.38
|
| Rate for Payer: Buckeye Medicare Advantage |
$147.38
|
| Rate for Payer: CareSource Just4Me Medicare |
$176.86
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$147.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.38
|
| 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 |
$191.59
|
| Rate for Payer: UHCCP Medicaid |
$315.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$147.38
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY(T
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
320T0162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,536.20 |
| 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 |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| 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 |
$2,908.23
|
| 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 |
$3,489.88
|
| 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 |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY(T
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75756
|
| Hospital Charge Code |
320T0162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,340.10 |
| 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 |
$3,573.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,886.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,082.23
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE
|
Professional
|
Both
|
$6,257.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.11 |
| Max. Negotiated Rate |
$3,754.20 |
| Rate for Payer: Aetna Commercial |
$444.95
|
| Rate for Payer: Ambetter Exchange |
$131.31
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$131.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$131.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$157.57
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$688.88
|
| Rate for Payer: Healthspan PPO |
$416.93
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.11
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$131.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$131.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$3,754.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$170.70
|
| Rate for Payer: UHCCP Medicaid |
$2,189.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$131.31
|
|
