|
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
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE
|
Facility
|
IP
|
$6,257.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
32000159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,877.10 |
| Max. Negotiated Rate |
$6,006.72 |
| Rate for Payer: Aetna Commercial |
$4,817.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,880.46
|
| Rate for Payer: Cash Price |
$3,128.50
|
| Rate for Payer: Cigna Commercial |
$5,193.31
|
| Rate for Payer: First Health Commercial |
$5,944.15
|
| Rate for Payer: Humana Commercial |
$5,318.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,130.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,617.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,877.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,506.16
|
| Rate for Payer: Ohio Health Group HMO |
$4,692.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,005.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,443.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,317.33
|
| Rate for Payer: PHCS Commercial |
$6,006.72
|
| Rate for Payer: United Healthcare All Payer |
$5,506.16
|
|
|
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: 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 |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| 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 |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$170.70
|
| Rate for Payer: UHCCP Medicaid |
$82.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$131.31
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE(T
|
Facility
|
OP
|
$6,022.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
320T0159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,070.97 |
| Max. Negotiated Rate |
$6,992.66 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Anthem Medicaid |
$2,070.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,697.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$3,011.00
|
| Rate for Payer: Cash Price |
$3,011.00
|
| Rate for Payer: Cigna Commercial |
$4,998.26
|
| Rate for Payer: First Health Commercial |
$5,720.90
|
| Rate for Payer: Humana Commercial |
$5,118.70
|
| Rate for Payer: Humana KY Medicaid |
$2,070.97
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,092.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,938.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,444.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,112.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,299.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,239.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,155.18
|
| Rate for Payer: PHCS Commercial |
$5,781.12
|
| Rate for Payer: United Healthcare All Payer |
$5,299.36
|
|
|
ANGIOGRAPHY PELVIC SELECTIVE(T
|
Facility
|
IP
|
$6,022.00
|
|
|
Service Code
|
HCPCS 75736
|
| Hospital Charge Code |
320T0159
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,806.60 |
| Max. Negotiated Rate |
$5,781.12 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,697.16
|
| Rate for Payer: Cash Price |
$3,011.00
|
| Rate for Payer: Cigna Commercial |
$4,998.26
|
| Rate for Payer: First Health Commercial |
$5,720.90
|
| Rate for Payer: Humana Commercial |
$5,118.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,938.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,444.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,806.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,299.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,817.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,239.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,155.18
|
| Rate for Payer: PHCS Commercial |
$5,781.12
|
| Rate for Payer: United Healthcare All Payer |
$5,299.36
|
|
|
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: Ambetter Exchange |
$87.80
|
| Rate for Payer: Anthem Medicaid |
$355.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.36
|
| 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 |
$316.39
|
| Rate for Payer: Humana Medicaid |
$355.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.80
|
| 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 |
$114.14
|
| Rate for Payer: UHCCP Medicaid |
$148.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$359.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.80
|
|
|
ANGIOGRAPHY SELECT EA ADD VES
|
Professional
|
Both
|
$3,892.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$2,335.20 |
| Rate for Payer: Aetna Commercial |
$337.66
|
| Rate for Payer: Ambetter Exchange |
$87.80
|
| Rate for Payer: Anthem Medicaid |
$355.69
|
| Rate for Payer: Buckeye Individual/Medicaid |
$87.80
|
| Rate for Payer: Buckeye Medicare Advantage |
$87.80
|
| Rate for Payer: CareSource Just4Me Medicare |
$105.36
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: Cigna Commercial |
$616.56
|
| Rate for Payer: Healthspan PPO |
$316.39
|
| Rate for Payer: Humana Medicaid |
$355.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$23.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$87.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$87.80
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$362.80
|
| Rate for Payer: Molina Healthcare Passport |
$355.69
|
| Rate for Payer: Multiplan PHCS |
$2,335.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$114.14
|
| Rate for Payer: UHCCP Medicaid |
$1,362.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$359.25
|
| Rate for Payer: Wellcare Medicare Advantage |
$87.80
|
|
|
ANGIOGRAPHY SELECT EA ADD VES
|
Facility
|
IP
|
$3,892.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$3,736.32 |
| Rate for Payer: Aetna Commercial |
$2,996.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,035.76
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: Cigna Commercial |
$3,230.36
|
| Rate for Payer: First Health Commercial |
$3,697.40
|
| Rate for Payer: Humana Commercial |
$3,308.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,191.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,872.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,424.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,386.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.48
|
| Rate for Payer: PHCS Commercial |
$3,736.32
|
| Rate for Payer: United Healthcare All Payer |
$3,424.96
|
|
|
ANGIOGRAPHY SELECT EA ADD VES
|
Facility
|
OP
|
$3,892.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
32000163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$3,736.32 |
| Rate for Payer: Aetna Commercial |
$2,996.84
|
| Rate for Payer: Anthem Medicaid |
$1,338.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,035.76
|
| Rate for Payer: Cash Price |
$1,946.00
|
| Rate for Payer: Cigna Commercial |
$3,230.36
|
| Rate for Payer: First Health Commercial |
$3,697.40
|
| Rate for Payer: Humana Commercial |
$3,308.20
|
| Rate for Payer: Humana KY Medicaid |
$1,338.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,352.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,191.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,872.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,365.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,424.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,919.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,113.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,386.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,685.48
|
| Rate for Payer: PHCS Commercial |
$3,736.32
|
| Rate for Payer: United Healthcare All Payer |
$3,424.96
|
|
|
ANGIOGRAPHY SELECT EA ADD VE(T
|
Facility
|
OP
|
$3,467.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
320T0163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,040.10 |
| Max. Negotiated Rate |
$3,328.32 |
| Rate for Payer: Aetna Commercial |
$2,669.59
|
| Rate for Payer: Anthem Medicaid |
$1,192.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,704.26
|
| Rate for Payer: Cash Price |
$1,733.50
|
| Rate for Payer: Cigna Commercial |
$2,877.61
|
| Rate for Payer: First Health Commercial |
$3,293.65
|
| Rate for Payer: Humana Commercial |
$2,946.95
|
| Rate for Payer: Humana KY Medicaid |
$1,192.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,204.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,842.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,558.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,216.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,050.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,600.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,016.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.23
|
| Rate for Payer: PHCS Commercial |
$3,328.32
|
| Rate for Payer: United Healthcare All Payer |
$3,050.96
|
|
|
ANGIOGRAPHY SELECT EA ADD VE(T
|
Facility
|
IP
|
$3,467.00
|
|
|
Service Code
|
HCPCS 75774
|
| Hospital Charge Code |
320T0163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,040.10 |
| Max. Negotiated Rate |
$3,328.32 |
| Rate for Payer: Aetna Commercial |
$2,669.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,704.26
|
| Rate for Payer: Cash Price |
$1,733.50
|
| Rate for Payer: Cigna Commercial |
$2,877.61
|
| Rate for Payer: First Health Commercial |
$3,293.65
|
| Rate for Payer: Humana Commercial |
$2,946.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,842.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,558.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,050.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,600.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,773.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,016.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.23
|
| Rate for Payer: PHCS Commercial |
$3,328.32
|
| Rate for Payer: United Healthcare All Payer |
$3,050.96
|
|
|
ANGIOGRAPHY - VISCERAL - SEL
|
Facility
|
IP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,470.50 |
| 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 |
$6,588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,164.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.15
|
| 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 |
$4,941.00 |
| Rate for Payer: Aetna Commercial |
$441.03
|
| Rate for Payer: Ambetter Exchange |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.49
|
| 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 |
$204.74
|
| Rate for Payer: UHCCP Medicaid |
$2,882.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.49
|
|
|
ANGIOGRAPHY - VISCERAL - SEL
|
Facility
|
OP
|
$8,235.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
32000158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,832.02 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,423.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,588.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,164.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,682.15
|
| Rate for Payer: PHCS Commercial |
$7,905.60
|
| Rate for Payer: United Healthcare All Payer |
$7,246.80
|
|
|
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: Ambetter Exchange |
$157.49
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$157.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$157.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$188.99
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$157.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$157.49
|
| 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 |
$204.74
|
| Rate for Payer: UHCCP Medicaid |
$117.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$157.49
|
|
|
ANGIOGRAPHY - VISCERAL - SEL(T
|
Facility
|
OP
|
$7,900.00
|
|
|
Service Code
|
HCPCS 75726
|
| Hospital Charge Code |
320T0158
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,716.81 |
| 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 |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,162.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$3,950.00
|
| 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 |
$4,994.76
|
| 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 |
$5,993.71
|
| 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 |
$6,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,873.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,451.00
|
| 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 |
$2,370.00 |
| 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 |
$6,320.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,873.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,451.00
|
| Rate for Payer: PHCS Commercial |
$7,584.00
|
| Rate for Payer: United Healthcare All Payer |
$6,952.00
|
|
|
ANGIOJET SOLENT DISTA CATH.
|
Facility
|
IP
|
$23,562.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,068.75 |
| Max. Negotiated Rate |
$22,620.00 |
| Rate for Payer: Aetna Commercial |
$18,143.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,378.75
|
| Rate for Payer: Cash Price |
$11,781.25
|
| Rate for Payer: Cigna Commercial |
$19,556.88
|
| Rate for Payer: First Health Commercial |
$22,384.38
|
| Rate for Payer: Humana Commercial |
$20,028.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,321.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,389.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,068.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,735.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,499.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,258.12
|
| Rate for Payer: PHCS Commercial |
$22,620.00
|
| Rate for Payer: United Healthcare All Payer |
$20,735.00
|
|
|
ANGIOJET SOLENT DISTA CATH.
|
Facility
|
OP
|
$23,562.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,068.75 |
| Max. Negotiated Rate |
$22,620.00 |
| Rate for Payer: Aetna Commercial |
$18,143.12
|
| Rate for Payer: Anthem Medicaid |
$8,103.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,378.75
|
| Rate for Payer: Cash Price |
$11,781.25
|
| Rate for Payer: Cigna Commercial |
$19,556.88
|
| Rate for Payer: First Health Commercial |
$22,384.38
|
| Rate for Payer: Humana Commercial |
$20,028.12
|
| Rate for Payer: Humana KY Medicaid |
$8,103.14
|
| Rate for Payer: Kentucky WC Medicaid |
$8,185.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,321.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,389.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,068.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,265.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$20,735.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,850.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,499.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,258.12
|
| Rate for Payer: PHCS Commercial |
$22,620.00
|
| Rate for Payer: United Healthcare All Payer |
$20,735.00
|
|
|
ANGIOMAX 1MG [250MG VIAL]
|
Facility
|
IP
|
$790.25
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
25001898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.07 |
| Max. Negotiated Rate |
$758.64 |
| Rate for Payer: Aetna Commercial |
$608.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$616.39
|
| 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 |
$237.07
|
| 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 |
$632.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.27
|
| 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 |
$237.07 |
| 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 |
$616.39
|
| 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 |
$237.07
|
| 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 |
$632.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$687.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.27
|
| 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 |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| 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 |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
ANGIOMAX KIT 1MG [250MG VIAL]
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
HCPCS J0583
|
| Hospital Charge Code |
25001899
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$506.88 |
| Rate for Payer: Aetna Commercial |
$406.56
|
| Rate for Payer: Anthem Medicaid |
$181.58
|
| 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: Humana KY Medicaid |
$181.58
|
| Rate for Payer: Kentucky WC Medicaid |
$183.43
|
| 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: Molina Healthcare Medicaid |
$185.22
|
| 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 |
$422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$364.32
|
| Rate for Payer: PHCS Commercial |
$506.88
|
| Rate for Payer: United Healthcare All Payer |
$464.64
|
|
|
ANGIOSCULPT 2*100
|
Facility
|
IP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
|
ANGIOSCULPT 2*100
|
Facility
|
OP
|
$7,197.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,159.25 |
| Max. Negotiated Rate |
$6,909.60 |
| Rate for Payer: Aetna Commercial |
$5,542.07
|
| Rate for Payer: Anthem Medicaid |
$2,475.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,614.05
|
| Rate for Payer: Cash Price |
$3,598.75
|
| Rate for Payer: Cigna Commercial |
$5,973.93
|
| Rate for Payer: First Health Commercial |
$6,837.62
|
| Rate for Payer: Humana Commercial |
$6,117.88
|
| Rate for Payer: Humana KY Medicaid |
$2,475.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,159.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,398.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,758.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,966.27
|
| Rate for Payer: PHCS Commercial |
$6,909.60
|
| Rate for Payer: United Healthcare All Payer |
$6,333.80
|
|
