|
MR ANGIOGRAPH NECK W/O&W/DYE
|
Facility
|
OP
|
$4,199.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
61000007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,031.04 |
| Rate for Payer: Aetna Commercial |
$3,233.23
|
| Rate for Payer: Anthem Medicaid |
$1,444.04
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,275.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,099.50
|
| Rate for Payer: Cash Price |
$2,099.50
|
| Rate for Payer: Cigna Commercial |
$3,485.17
|
| Rate for Payer: First Health Commercial |
$3,989.05
|
| Rate for Payer: Humana Commercial |
$3,569.15
|
| Rate for Payer: Humana KY Medicaid |
$1,444.04
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,458.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,443.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,098.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,473.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,695.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$839.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$545.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,301.69
|
| Rate for Payer: PHCS Commercial |
$4,031.04
|
| Rate for Payer: United Healthcare All Payer |
$3,695.12
|
|
|
MR ANGIOGRAPH NECK W/O&W/DYE
|
Professional
|
Both
|
$4,199.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
61000007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$114.23 |
| Max. Negotiated Rate |
$4,199.00 |
| Rate for Payer: Aetna Commercial |
$950.53
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,199.00
|
| Rate for Payer: Cash Price |
$2,099.50
|
| Rate for Payer: Cash Price |
$2,099.50
|
| Rate for Payer: Cigna Commercial |
$1,399.70
|
| Rate for Payer: Healthspan PPO |
$653.16
|
| Rate for Payer: Humana Medicaid |
$656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.78
|
| Rate for Payer: Molina Healthcare Passport |
$656.65
|
| Rate for Payer: Multiplan PHCS |
$2,519.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,939.30
|
| Rate for Payer: UHCCP Medicaid |
$1,469.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
|
|
MR ANGIOGRAPH NECK W/O&W/DY(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
610P0007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$1,399.70 |
| Rate for Payer: Aetna Commercial |
$950.53
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$1,399.70
|
| Rate for Payer: Healthspan PPO |
$653.16
|
| Rate for Payer: Humana Medicaid |
$656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.78
|
| Rate for Payer: Molina Healthcare Passport |
$656.65
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
|
|
MR ANGIOGRAPH NECK W/O&W/DY(T
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
610T0007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem Medicaid |
$1,375.26
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Humana KY Medicaid |
$1,375.26
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,389.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,402.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MR ANGIOGRAPH NECK W/O&W/DY(T
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
610T0007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$519.87 |
| Max. Negotiated Rate |
$3,839.04 |
| Rate for Payer: Aetna Commercial |
$3,079.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,119.22
|
| Rate for Payer: Cash Price |
$1,999.50
|
| Rate for Payer: Cigna Commercial |
$3,319.17
|
| Rate for Payer: First Health Commercial |
$3,799.05
|
| Rate for Payer: Humana Commercial |
$3,399.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,279.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,951.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,199.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,519.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,999.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$799.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$519.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,239.69
|
| Rate for Payer: PHCS Commercial |
$3,839.04
|
| Rate for Payer: United Healthcare All Payer |
$3,519.12
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE
|
Professional
|
Both
|
$3,579.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$3,579.00 |
| Rate for Payer: Aetna Commercial |
$619.56
|
| Rate for Payer: Anthem Medicaid |
$411.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,579.00
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$787.12
|
| Rate for Payer: Healthspan PPO |
$425.73
|
| Rate for Payer: Humana Medicaid |
$411.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.74
|
| Rate for Payer: Molina Healthcare Passport |
$411.51
|
| Rate for Payer: Multiplan PHCS |
$2,147.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,505.30
|
| Rate for Payer: UHCCP Medicaid |
$1,252.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.63
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE
|
Facility
|
OP
|
$3,579.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,435.84 |
| Rate for Payer: Aetna Commercial |
$2,755.83
|
| Rate for Payer: Anthem Medicaid |
$1,230.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,791.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$2,970.57
|
| Rate for Payer: First Health Commercial |
$3,400.05
|
| Rate for Payer: Humana Commercial |
$3,042.15
|
| Rate for Payer: Humana KY Medicaid |
$1,230.82
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,243.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,934.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,641.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,255.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,149.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,684.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.49
|
| Rate for Payer: PHCS Commercial |
$3,435.84
|
| Rate for Payer: United Healthcare All Payer |
$3,149.52
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE
|
Facility
|
IP
|
$3,579.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$465.27 |
| Max. Negotiated Rate |
$3,435.84 |
| Rate for Payer: Aetna Commercial |
$2,755.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,791.62
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$2,970.57
|
| Rate for Payer: First Health Commercial |
$3,400.05
|
| Rate for Payer: Humana Commercial |
$3,042.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,934.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,641.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,073.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,149.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,684.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$715.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,109.49
|
| Rate for Payer: PHCS Commercial |
$3,435.84
|
| Rate for Payer: United Healthcare All Payer |
$3,149.52
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
610P0005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$787.12 |
| Rate for Payer: Aetna Commercial |
$619.56
|
| Rate for Payer: Anthem Medicaid |
$411.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$787.12
|
| Rate for Payer: Healthspan PPO |
$425.73
|
| Rate for Payer: Humana Medicaid |
$411.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.74
|
| Rate for Payer: Molina Healthcare Passport |
$411.51
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.63
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
610T0005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem Medicaid |
$1,179.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Humana KY Medicaid |
$1,179.23
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
610T0005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$445.77 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MR ANGIOGRAPHY NECK W/DYE
|
Professional
|
Both
|
$3,377.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
61000052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$3,377.00 |
| Rate for Payer: Aetna Commercial |
$738.54
|
| Rate for Payer: Anthem Medicaid |
$346.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,377.00
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$797.59
|
| Rate for Payer: Healthspan PPO |
$507.48
|
| Rate for Payer: Humana Medicaid |
$346.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.86
|
| Rate for Payer: Molina Healthcare Passport |
$346.92
|
| Rate for Payer: Multiplan PHCS |
$2,026.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,363.90
|
| Rate for Payer: UHCCP Medicaid |
$1,181.95
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.39
|
|
|
MR ANGIOGRAPHY NECK W/DYE
|
Facility
|
OP
|
$3,377.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
61000052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,241.92 |
| Rate for Payer: Aetna Commercial |
$2,600.29
|
| Rate for Payer: Anthem Medicaid |
$1,161.35
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$2,802.91
|
| Rate for Payer: First Health Commercial |
$3,208.15
|
| Rate for Payer: Humana Commercial |
$2,870.45
|
| Rate for Payer: Humana KY Medicaid |
$1,161.35
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.87
|
| Rate for Payer: PHCS Commercial |
$3,241.92
|
| Rate for Payer: United Healthcare All Payer |
$2,971.76
|
|
|
MR ANGIOGRAPHY NECK W/DYE
|
Facility
|
IP
|
$3,377.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
61000052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$439.01 |
| Max. Negotiated Rate |
$3,241.92 |
| Rate for Payer: Aetna Commercial |
$2,600.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.06
|
| Rate for Payer: Cash Price |
$1,688.50
|
| Rate for Payer: Cigna Commercial |
$2,802.91
|
| Rate for Payer: First Health Commercial |
$3,208.15
|
| Rate for Payer: Humana Commercial |
$2,870.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.87
|
| Rate for Payer: PHCS Commercial |
$3,241.92
|
| Rate for Payer: United Healthcare All Payer |
$2,971.76
|
|
|
MR ANGIOGRAPHY NECK W/DYE(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
610P0052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$797.59 |
| Rate for Payer: Aetna Commercial |
$738.54
|
| Rate for Payer: Anthem Medicaid |
$346.92
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$797.59
|
| Rate for Payer: Healthspan PPO |
$507.48
|
| Rate for Payer: Humana Medicaid |
$346.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.86
|
| Rate for Payer: Molina Healthcare Passport |
$346.92
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.39
|
|
|
MR ANGIOGRAPHY NECK W/DYE(T
|
Facility
|
OP
|
$3,227.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
610T0052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$3,097.92 |
| Rate for Payer: Aetna Commercial |
$2,484.79
|
| Rate for Payer: Anthem Medicaid |
$1,109.77
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,517.06
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,613.50
|
| Rate for Payer: Cash Price |
$1,613.50
|
| Rate for Payer: Cigna Commercial |
$2,678.41
|
| Rate for Payer: First Health Commercial |
$3,065.65
|
| Rate for Payer: Humana Commercial |
$2,742.95
|
| Rate for Payer: Humana KY Medicaid |
$1,109.77
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,121.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,646.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,381.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,839.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,420.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.37
|
| Rate for Payer: PHCS Commercial |
$3,097.92
|
| Rate for Payer: United Healthcare All Payer |
$2,839.76
|
|
|
MR ANGIOGRAPHY NECK W/DYE(T
|
Facility
|
IP
|
$3,227.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
610T0052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$419.51 |
| Max. Negotiated Rate |
$3,097.92 |
| Rate for Payer: Aetna Commercial |
$2,484.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,517.06
|
| Rate for Payer: Cash Price |
$1,613.50
|
| Rate for Payer: Cigna Commercial |
$2,678.41
|
| Rate for Payer: First Health Commercial |
$3,065.65
|
| Rate for Payer: Humana Commercial |
$2,742.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,646.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,381.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,839.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,420.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.37
|
| Rate for Payer: PHCS Commercial |
$3,097.92
|
| Rate for Payer: United Healthcare All Payer |
$2,839.76
|
|
|
MR ANGIOGRAPHY NECK W/O DYE
|
Professional
|
Both
|
$3,869.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$3,869.00 |
| Rate for Payer: Aetna Commercial |
$619.74
|
| Rate for Payer: Anthem Medicaid |
$410.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,869.00
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$786.56
|
| Rate for Payer: Healthspan PPO |
$425.85
|
| Rate for Payer: Humana Medicaid |
$410.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$418.70
|
| Rate for Payer: Molina Healthcare Passport |
$410.49
|
| Rate for Payer: Multiplan PHCS |
$2,321.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,708.30
|
| Rate for Payer: UHCCP Medicaid |
$1,354.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.59
|
|
|
MR ANGIOGRAPHY NECK W/O DYE
|
Facility
|
IP
|
$3,869.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$502.97 |
| Max. Negotiated Rate |
$3,714.24 |
| Rate for Payer: Aetna Commercial |
$2,979.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.82
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$3,211.27
|
| Rate for Payer: First Health Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial |
$3,288.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.39
|
| Rate for Payer: PHCS Commercial |
$3,714.24
|
| Rate for Payer: United Healthcare All Payer |
$3,404.72
|
|
|
MR ANGIOGRAPHY NECK W/O DYE
|
Facility
|
OP
|
$3,869.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,714.24 |
| Rate for Payer: Aetna Commercial |
$2,979.13
|
| Rate for Payer: Anthem Medicaid |
$1,330.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,017.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cash Price |
$1,934.50
|
| Rate for Payer: Cigna Commercial |
$3,211.27
|
| Rate for Payer: First Health Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial |
$3,288.65
|
| Rate for Payer: Humana KY Medicaid |
$1,330.55
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,404.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,901.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.39
|
| Rate for Payer: PHCS Commercial |
$3,714.24
|
| Rate for Payer: United Healthcare All Payer |
$3,404.72
|
|
|
MR ANGIOGRAPHY NECK W/O DYE(P
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
610P0006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$786.56 |
| Rate for Payer: Aetna Commercial |
$619.74
|
| Rate for Payer: Anthem Medicaid |
$410.49
|
| Rate for Payer: Buckeye Medicare Advantage |
$440.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cigna Commercial |
$786.56
|
| Rate for Payer: Healthspan PPO |
$425.85
|
| Rate for Payer: Humana Medicaid |
$410.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$418.70
|
| Rate for Payer: Molina Healthcare Passport |
$410.49
|
| Rate for Payer: Multiplan PHCS |
$264.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$308.00
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.59
|
|
|
MR ANGIOGRAPHY NECK W/O DYE(T
|
Facility
|
OP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
610T0006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem Medicaid |
$1,179.23
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Humana KY Medicaid |
$1,179.23
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MR ANGIOGRAPHY NECK W/O DYE(T
|
Facility
|
IP
|
$3,429.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
610T0006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$445.77 |
| Max. Negotiated Rate |
$3,291.84 |
| Rate for Payer: Aetna Commercial |
$2,640.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.62
|
| Rate for Payer: Cash Price |
$1,714.50
|
| Rate for Payer: Cigna Commercial |
$2,846.07
|
| Rate for Payer: First Health Commercial |
$3,257.55
|
| Rate for Payer: Humana Commercial |
$2,914.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.99
|
| Rate for Payer: PHCS Commercial |
$3,291.84
|
| Rate for Payer: United Healthcare All Payer |
$3,017.52
|
|
|
MR ANGIO PELVIS W/O & W/DYE
|
Professional
|
Both
|
$4,164.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$114.23 |
| Max. Negotiated Rate |
$4,164.00 |
| Rate for Payer: Aetna Commercial |
$788.34
|
| Rate for Payer: Anthem Medicaid |
$377.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,164.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$817.93
|
| Rate for Payer: Healthspan PPO |
$541.71
|
| Rate for Payer: Humana Medicaid |
$377.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.23
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$385.09
|
| Rate for Payer: Molina Healthcare Passport |
$377.54
|
| Rate for Payer: Multiplan PHCS |
$2,498.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,914.80
|
| Rate for Payer: UHCCP Medicaid |
$1,457.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.32
|
|
|
MR ANGIO PELVIS W/O & W/DYE
|
Facility
|
IP
|
$4,164.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$541.32 |
| Max. Negotiated Rate |
$3,997.44 |
| Rate for Payer: Aetna Commercial |
$3,206.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,247.92
|
| Rate for Payer: Cash Price |
$2,082.00
|
| Rate for Payer: Cigna Commercial |
$3,456.12
|
| Rate for Payer: First Health Commercial |
$3,955.80
|
| Rate for Payer: Humana Commercial |
$3,539.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$832.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$541.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,290.84
|
| Rate for Payer: PHCS Commercial |
$3,997.44
|
| Rate for Payer: United Healthcare All Payer |
$3,664.32
|
|
