|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
OP
|
$5,302.00
|
|
|
Service Code
|
HCPCS 41008
|
| Hospital Charge Code |
76101645
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,823.36 |
| Max. Negotiated Rate |
$5,089.92 |
| Rate for Payer: Aetna Commercial |
$4,082.54
|
| Rate for Payer: Anthem Medicaid |
$1,823.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,996.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,135.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,195.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,045.32
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cash Price |
$2,651.00
|
| Rate for Payer: Cigna Commercial |
$4,400.66
|
| Rate for Payer: First Health Commercial |
$5,036.90
|
| Rate for Payer: Humana Commercial |
$4,506.70
|
| Rate for Payer: Humana KY Medicaid |
$1,823.36
|
| Rate for Payer: Humana Medicare Advantage |
$2,996.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,841.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,347.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,912.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,595.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,859.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,665.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,976.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,612.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,658.38
|
| Rate for Payer: PHCS Commercial |
$5,089.92
|
| Rate for Payer: United Healthcare All Payer |
$4,665.76
|
|
|
INTRAORAL I/D ABSC CYST/HEMAT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
HCPCS 41005
|
| Hospital Charge Code |
76101644
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$760.32 |
| Rate for Payer: Aetna Commercial |
$609.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$617.76
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$657.36
|
| Rate for Payer: First Health Commercial |
$752.40
|
| Rate for Payer: Humana Commercial |
$673.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$649.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$584.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$237.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$696.96
|
| Rate for Payer: Ohio Health Group HMO |
$594.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$689.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$546.48
|
| Rate for Payer: PHCS Commercial |
$760.32
|
| Rate for Payer: United Healthcare All Payer |
$696.96
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
OP
|
$1,993.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.90 |
| Max. Negotiated Rate |
$1,913.28 |
| Rate for Payer: Aetna Commercial |
$1,534.61
|
| Rate for Payer: Anthem Medicaid |
$685.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.54
|
| Rate for Payer: Cash Price |
$996.50
|
| Rate for Payer: Cigna Commercial |
$1,654.19
|
| Rate for Payer: First Health Commercial |
$1,893.35
|
| Rate for Payer: Humana Commercial |
$1,694.05
|
| Rate for Payer: Humana KY Medicaid |
$685.39
|
| Rate for Payer: Kentucky WC Medicaid |
$692.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,470.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,753.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.17
|
| Rate for Payer: PHCS Commercial |
$1,913.28
|
| Rate for Payer: United Healthcare All Payer |
$1,753.84
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
IP
|
$1,993.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
48100081
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$597.90 |
| Max. Negotiated Rate |
$1,913.28 |
| Rate for Payer: Aetna Commercial |
$1,534.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.54
|
| Rate for Payer: Cash Price |
$996.50
|
| Rate for Payer: Cigna Commercial |
$1,654.19
|
| Rate for Payer: First Health Commercial |
$1,893.35
|
| Rate for Payer: Humana Commercial |
$1,694.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,470.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,753.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,733.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.17
|
| Rate for Payer: PHCS Commercial |
$1,913.28
|
| Rate for Payer: United Healthcare All Payer |
$1,753.84
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Professional
|
Both
|
$6,330.00
|
|
| Hospital Charge Code |
76102514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,215.50 |
| Max. Negotiated Rate |
$4,431.00 |
| Rate for Payer: Cash Price |
$3,165.00
|
| Rate for Payer: Multiplan PHCS |
$3,798.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,431.00
|
| Rate for Payer: UHCCP Medicaid |
$2,215.50
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
IP
|
$6,330.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
76102514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,899.00 |
| Max. Negotiated Rate |
$6,076.80 |
| Rate for Payer: Aetna Commercial |
$4,874.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,937.40
|
| Rate for Payer: Cash Price |
$3,165.00
|
| Rate for Payer: Cigna Commercial |
$5,253.90
|
| Rate for Payer: First Health Commercial |
$6,013.50
|
| Rate for Payer: Humana Commercial |
$5,380.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,190.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,671.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,899.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,507.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,367.70
|
| Rate for Payer: PHCS Commercial |
$6,076.80
|
| Rate for Payer: United Healthcare All Payer |
$5,570.40
|
|
|
INTRAPROCEDURAL CORONARY FFR
|
Facility
|
OP
|
$6,330.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
76102514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,899.00 |
| Max. Negotiated Rate |
$6,076.80 |
| Rate for Payer: Aetna Commercial |
$4,874.10
|
| Rate for Payer: Anthem Medicaid |
$2,176.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,937.40
|
| Rate for Payer: Cash Price |
$3,165.00
|
| Rate for Payer: Cigna Commercial |
$5,253.90
|
| Rate for Payer: First Health Commercial |
$6,013.50
|
| Rate for Payer: Humana Commercial |
$5,380.50
|
| Rate for Payer: Humana KY Medicaid |
$2,176.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,199.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,190.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,671.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,899.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,220.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,570.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,747.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,064.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,507.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,367.70
|
| Rate for Payer: PHCS Commercial |
$6,076.80
|
| Rate for Payer: United Healthcare All Payer |
$5,570.40
|
|
|
INTRAPROCEDURAL CORONARY FFR(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
761P2514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
|
|
INTRAPROCEDURAL CORONARY FFR(T
|
Facility
|
IP
|
$6,030.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
761T2514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,809.00 |
| Max. Negotiated Rate |
$5,788.80 |
| Rate for Payer: Aetna Commercial |
$4,643.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,703.40
|
| Rate for Payer: Cash Price |
$3,015.00
|
| Rate for Payer: Cigna Commercial |
$5,004.90
|
| Rate for Payer: First Health Commercial |
$5,728.50
|
| Rate for Payer: Humana Commercial |
$5,125.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,944.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,306.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,246.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,160.70
|
| Rate for Payer: PHCS Commercial |
$5,788.80
|
| Rate for Payer: United Healthcare All Payer |
$5,306.40
|
|
|
INTRAPROCEDURAL CORONARY FFR(T
|
Facility
|
OP
|
$6,030.00
|
|
|
Service Code
|
HCPCS 0523T
|
| Hospital Charge Code |
761T2514
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,809.00 |
| Max. Negotiated Rate |
$5,788.80 |
| Rate for Payer: Aetna Commercial |
$4,643.10
|
| Rate for Payer: Anthem Medicaid |
$2,073.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,703.40
|
| Rate for Payer: Cash Price |
$3,015.00
|
| Rate for Payer: Cigna Commercial |
$5,004.90
|
| Rate for Payer: First Health Commercial |
$5,728.50
|
| Rate for Payer: Humana Commercial |
$5,125.50
|
| Rate for Payer: Humana KY Medicaid |
$2,073.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,094.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,944.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,450.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,809.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,115.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,306.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,522.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,246.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,160.70
|
| Rate for Payer: PHCS Commercial |
$5,788.80
|
| Rate for Payer: United Healthcare All Payer |
$5,306.40
|
|
|
INTRASPINAL TRIAL KIT 8516
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem Medicaid |
$523.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Humana KY Medicaid |
$523.76
|
| Rate for Payer: Kentucky WC Medicaid |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
INTRASPINAL TRIAL KIT 8516
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1897
|
| Hospital Charge Code |
27000065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
INTRAVA DOP VELOCITY ADTL VE(P
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
761P2493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$267.83 |
| Rate for Payer: Aetna Commercial |
$267.83
|
| Rate for Payer: Anthem Medicaid |
$182.19
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cash Price |
$120.50
|
| Rate for Payer: Cigna Commercial |
$247.78
|
| Rate for Payer: Healthspan PPO |
$253.42
|
| Rate for Payer: Humana Medicaid |
$182.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.83
|
| Rate for Payer: Molina Healthcare Passport |
$182.19
|
| Rate for Payer: Multiplan PHCS |
$144.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$168.70
|
| Rate for Payer: UHCCP Medicaid |
$84.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.01
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
IP
|
$871.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
76102493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.99
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
48100080
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$644.16 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Anthem Medicaid |
$230.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$523.38
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cigna Commercial |
$556.93
|
| Rate for Payer: First Health Commercial |
$637.45
|
| Rate for Payer: Humana Commercial |
$570.35
|
| Rate for Payer: Humana KY Medicaid |
$230.76
|
| Rate for Payer: Kentucky WC Medicaid |
$233.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$550.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$495.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$201.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$235.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$590.48
|
| Rate for Payer: Ohio Health Group HMO |
$503.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$583.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$462.99
|
| Rate for Payer: PHCS Commercial |
$644.16
|
| Rate for Payer: United Healthcare All Payer |
$590.48
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
76102493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$267.83
|
| Rate for Payer: Anthem Medicaid |
$182.19
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$247.78
|
| Rate for Payer: Healthspan PPO |
$253.42
|
| Rate for Payer: Humana Medicaid |
$182.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$101.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$185.83
|
| Rate for Payer: Molina Healthcare Passport |
$182.19
|
| Rate for Payer: Multiplan PHCS |
$522.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$609.70
|
| Rate for Payer: UHCCP Medicaid |
$304.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$184.01
|
|
|
INTRAVA DOP VELOCITY ADTL VES
|
Facility
|
OP
|
$871.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
76102493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$836.16 |
| Rate for Payer: Aetna Commercial |
$670.67
|
| Rate for Payer: Anthem Medicaid |
$299.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$679.38
|
| Rate for Payer: Cash Price |
$435.50
|
| Rate for Payer: Cigna Commercial |
$722.93
|
| Rate for Payer: First Health Commercial |
$827.45
|
| Rate for Payer: Humana Commercial |
$740.35
|
| Rate for Payer: Humana KY Medicaid |
$299.54
|
| Rate for Payer: Kentucky WC Medicaid |
$302.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$714.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$642.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$261.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$305.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$766.48
|
| Rate for Payer: Ohio Health Group HMO |
$653.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$757.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$600.99
|
| Rate for Payer: PHCS Commercial |
$836.16
|
| Rate for Payer: United Healthcare All Payer |
$766.48
|
|
|
INTRAVA DOP VELOCITY ADTL VE(T
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
761T2493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.70
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
INTRAVA DOP VELOCITY ADTL VE(T
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 93572
|
| Hospital Charge Code |
761T2493
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$604.80 |
| Rate for Payer: Aetna Commercial |
$485.10
|
| Rate for Payer: Anthem Medicaid |
$216.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$491.40
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Cigna Commercial |
$522.90
|
| Rate for Payer: First Health Commercial |
$598.50
|
| Rate for Payer: Humana Commercial |
$535.50
|
| Rate for Payer: Humana KY Medicaid |
$216.66
|
| Rate for Payer: Kentucky WC Medicaid |
$218.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$516.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$464.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$189.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$221.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$554.40
|
| Rate for Payer: Ohio Health Group HMO |
$472.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.70
|
| Rate for Payer: PHCS Commercial |
$604.80
|
| Rate for Payer: United Healthcare All Payer |
$554.40
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
OP
|
$3,036.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
76102470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.90 |
| Max. Negotiated Rate |
$2,914.88 |
| Rate for Payer: Aetna Commercial |
$2,337.97
|
| Rate for Payer: Anthem Medicaid |
$1,044.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.34
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cigna Commercial |
$2,520.15
|
| Rate for Payer: First Health Commercial |
$2,884.51
|
| Rate for Payer: Humana Commercial |
$2,580.88
|
| Rate for Payer: Humana KY Medicaid |
$1,044.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.07
|
| Rate for Payer: PHCS Commercial |
$2,914.88
|
| Rate for Payer: United Healthcare All Payer |
$2,671.97
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
IP
|
$2,432.00
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
48100060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.60 |
| Max. Negotiated Rate |
$2,334.72 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,896.96
|
| Rate for Payer: Cash Price |
$1,216.00
|
| Rate for Payer: Cigna Commercial |
$2,018.56
|
| Rate for Payer: First Health Commercial |
$2,310.40
|
| Rate for Payer: Humana Commercial |
$2,067.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,994.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,794.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$729.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,140.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,824.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,678.08
|
| Rate for Payer: PHCS Commercial |
$2,334.72
|
| Rate for Payer: United Healthcare All Payer |
$2,140.16
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
IP
|
$3,036.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
76102470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$910.90 |
| Max. Negotiated Rate |
$2,914.88 |
| Rate for Payer: Aetna Commercial |
$2,337.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,368.34
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cigna Commercial |
$2,520.15
|
| Rate for Payer: First Health Commercial |
$2,884.51
|
| Rate for Payer: Humana Commercial |
$2,580.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,277.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,429.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,095.07
|
| Rate for Payer: PHCS Commercial |
$2,914.88
|
| Rate for Payer: United Healthcare All Payer |
$2,671.97
|
|
|
INTRAVASC EA ADDL VESSEL
|
Professional
|
Both
|
$3,036.33
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
76102470
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$2,125.43 |
| Rate for Payer: Aetna Commercial |
$282.45
|
| Rate for Payer: Anthem Medicaid |
$124.47
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cash Price |
$1,518.16
|
| Rate for Payer: Cigna Commercial |
$262.77
|
| Rate for Payer: Healthspan PPO |
$256.10
|
| Rate for Payer: Humana Medicaid |
$124.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$102.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$126.96
|
| Rate for Payer: Molina Healthcare Passport |
$124.47
|
| Rate for Payer: Multiplan PHCS |
$1,821.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,125.43
|
| Rate for Payer: UHCCP Medicaid |
$1,062.72
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$125.71
|
|
|
INTRAVASC EA ADDL VESSEL
|
Facility
|
OP
|
$2,432.00
|
|
|
Service Code
|
HCPCS 92979
|
| Hospital Charge Code |
48100060
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$729.60 |
| Max. Negotiated Rate |
$2,334.72 |
| Rate for Payer: Aetna Commercial |
$1,872.64
|
| Rate for Payer: Anthem Medicaid |
$836.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,896.96
|
| Rate for Payer: Cash Price |
$1,216.00
|
| Rate for Payer: Cigna Commercial |
$2,018.56
|
| Rate for Payer: First Health Commercial |
$2,310.40
|
| Rate for Payer: Humana Commercial |
$2,067.20
|
| Rate for Payer: Humana KY Medicaid |
$836.36
|
| Rate for Payer: Kentucky WC Medicaid |
$844.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,994.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,794.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$729.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$853.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,140.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,824.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,945.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,115.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,678.08
|
| Rate for Payer: PHCS Commercial |
$2,334.72
|
| Rate for Payer: United Healthcare All Payer |
$2,140.16
|
|
