|
MR ANGIO PELVIS W/O & W/DYE
|
Facility
|
OP
|
$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 Medicaid |
$1,432.00
|
| 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: Humana KY Medicaid |
$1,432.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,446.57
|
| 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: Molina Healthcare Medicaid |
$1,460.73
|
| 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
|
|
|
MR ANGIO PELVIS W/O & W/DYE(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
610P0026
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$817.93 |
| Rate for Payer: Aetna Commercial |
$788.34
|
| Rate for Payer: Anthem Medicaid |
$377.54
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| 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 |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.32
|
|
|
MR ANGIO PELVIS W/O & W/DYE(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
610T0026
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANGIO PELVIS W/O & W/DYE(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
610T0026
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANGIO UPR EXTR W/O&W/DYE
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
61000033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$4,045.44 |
| Rate for Payer: Aetna Commercial |
$3,244.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,286.92
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,497.62
|
| Rate for Payer: First Health Commercial |
$4,003.30
|
| Rate for Payer: Humana Commercial |
$3,581.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,455.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,109.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,708.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.34
|
| Rate for Payer: PHCS Commercial |
$4,045.44
|
| Rate for Payer: United Healthcare All Payer |
$3,708.32
|
|
|
MR ANGIO UPR EXTR W/O&W/DYE
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
61000033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$4,045.44 |
| Rate for Payer: Aetna Commercial |
$3,244.78
|
| Rate for Payer: Anthem Medicaid |
$1,449.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,286.92
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$3,497.62
|
| Rate for Payer: First Health Commercial |
$4,003.30
|
| Rate for Payer: Humana Commercial |
$3,581.90
|
| Rate for Payer: Humana KY Medicaid |
$1,449.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,455.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,109.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,478.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,708.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,160.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,306.34
|
| Rate for Payer: PHCS Commercial |
$4,045.44
|
| Rate for Payer: United Healthcare All Payer |
$3,708.32
|
|
|
MR ANGIO UPR EXTR W/O&W/DYE
|
Professional
|
Both
|
$4,214.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
61000033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$4,214.00 |
| Rate for Payer: Aetna Commercial |
$958.20
|
| Rate for Payer: Anthem Medicaid |
$373.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,214.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cash Price |
$2,107.00
|
| Rate for Payer: Cigna Commercial |
$813.88
|
| Rate for Payer: Healthspan PPO |
$698.88
|
| Rate for Payer: Humana Medicaid |
$373.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.10
|
| Rate for Payer: Molina Healthcare Passport |
$373.63
|
| Rate for Payer: Multiplan PHCS |
$2,528.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,949.80
|
| Rate for Payer: UHCCP Medicaid |
$1,474.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.37
|
|
|
MR ANGIO UPR EXTR W/O&W/DYE(P
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
610P0033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$958.20 |
| Rate for Payer: Aetna Commercial |
$958.20
|
| Rate for Payer: Anthem Medicaid |
$373.63
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Cigna Commercial |
$813.88
|
| Rate for Payer: Healthspan PPO |
$698.88
|
| Rate for Payer: Humana Medicaid |
$373.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$110.00
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$381.10
|
| Rate for Payer: Molina Healthcare Passport |
$373.63
|
| Rate for Payer: Multiplan PHCS |
$210.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$245.00
|
| Rate for Payer: UHCCP Medicaid |
$122.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$377.37
|
|
|
MR ANGIO UPR EXTR W/O&W/DYE(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
610T0033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANGIO UPR EXTR W/O&W/DYE(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73225
|
| Hospital Charge Code |
610T0033
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANG LWR EXT W OR W/O DYE
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
61000040
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANG LWR EXT W OR W/O DYE
|
Professional
|
Both
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
61000040
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$790.74
|
| Rate for Payer: Anthem Medicaid |
$376.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,864.00
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$820.77
|
| Rate for Payer: Healthspan PPO |
$543.36
|
| Rate for Payer: Humana Medicaid |
$376.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$115.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$383.80
|
| Rate for Payer: Molina Healthcare Passport |
$376.27
|
| Rate for Payer: Multiplan PHCS |
$2,318.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,704.80
|
| Rate for Payer: UHCCP Medicaid |
$1,352.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$380.03
|
|
|
MR ANG LWR EXT W OR W/O DYE
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
61000040
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANG LWR EXT W OR W/O DYE(T
|
Facility
|
IP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
610T0040
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MR ANG LWR EXT W OR W/O DYE(T
|
Facility
|
OP
|
$3,864.00
|
|
|
Service Code
|
HCPCS 73725
|
| Hospital Charge Code |
610T0040
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$502.32 |
| Max. Negotiated Rate |
$3,709.44 |
| Rate for Payer: Aetna Commercial |
$2,975.28
|
| Rate for Payer: Anthem Medicaid |
$1,328.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,013.92
|
| Rate for Payer: Cash Price |
$1,932.00
|
| Rate for Payer: Cigna Commercial |
$3,207.12
|
| Rate for Payer: First Health Commercial |
$3,670.80
|
| Rate for Payer: Humana Commercial |
$3,284.40
|
| Rate for Payer: Humana KY Medicaid |
$1,328.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,342.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,168.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,851.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,159.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,355.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,400.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,898.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.84
|
| Rate for Payer: PHCS Commercial |
$3,709.44
|
| Rate for Payer: United Healthcare All Payer |
$3,400.32
|
|
|
MRA w/cont, abd
|
Facility
|
OP
|
$2,479.00
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$2,379.84 |
| Rate for Payer: Aetna Commercial |
$1,908.83
|
| Rate for Payer: Anthem Medicaid |
$852.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$2,057.57
|
| Rate for Payer: First Health Commercial |
$2,355.05
|
| Rate for Payer: Humana Commercial |
$2,107.15
|
| Rate for Payer: Humana KY Medicaid |
$852.53
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$861.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$869.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,859.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.49
|
| Rate for Payer: PHCS Commercial |
$2,379.84
|
| Rate for Payer: United Healthcare All Payer |
$2,181.52
|
|
|
MRA w/cont, abd
|
Facility
|
IP
|
$2,479.00
|
|
|
Service Code
|
HCPCS C8900
|
| Hospital Charge Code |
61000086
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$2,379.84 |
| Rate for Payer: Aetna Commercial |
$1,908.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.62
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$2,057.57
|
| Rate for Payer: First Health Commercial |
$2,355.05
|
| Rate for Payer: Humana Commercial |
$2,107.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,859.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.49
|
| Rate for Payer: PHCS Commercial |
$2,379.84
|
| Rate for Payer: United Healthcare All Payer |
$2,181.52
|
|
|
MRA w/o cont, abd
|
Facility
|
IP
|
$2,588.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$336.44 |
| Max. Negotiated Rate |
$2,484.48 |
| Rate for Payer: Aetna Commercial |
$1,992.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,018.64
|
| Rate for Payer: Cash Price |
$1,294.00
|
| Rate for Payer: Cigna Commercial |
$2,148.04
|
| Rate for Payer: First Health Commercial |
$2,458.60
|
| Rate for Payer: Humana Commercial |
$2,199.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,122.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$776.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,277.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,941.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$802.28
|
| Rate for Payer: PHCS Commercial |
$2,484.48
|
| Rate for Payer: United Healthcare All Payer |
$2,277.44
|
|
|
MRA w/o cont, abd
|
Facility
|
OP
|
$2,588.00
|
|
|
Service Code
|
HCPCS C8901
|
| Hospital Charge Code |
61000087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.90 |
| Max. Negotiated Rate |
$2,484.48 |
| Rate for Payer: Aetna Commercial |
$1,992.76
|
| Rate for Payer: Anthem Medicaid |
$890.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$211.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,018.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$296.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$286.06
|
| Rate for Payer: Cash Price |
$1,294.00
|
| Rate for Payer: Cash Price |
$1,294.00
|
| Rate for Payer: Cigna Commercial |
$2,148.04
|
| Rate for Payer: First Health Commercial |
$2,458.60
|
| Rate for Payer: Humana Commercial |
$2,199.80
|
| Rate for Payer: Humana KY Medicaid |
$890.01
|
| Rate for Payer: Humana Medicare Advantage |
$211.90
|
| Rate for Payer: Kentucky WC Medicaid |
$899.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,122.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,909.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$254.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$907.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,277.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,941.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$517.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$336.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$802.28
|
| Rate for Payer: PHCS Commercial |
$2,484.48
|
| Rate for Payer: United Healthcare All Payer |
$2,277.44
|
|
|
MRA w/o fol w/cont, abd
|
Facility
|
OP
|
$2,479.00
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$2,379.84 |
| Rate for Payer: Aetna Commercial |
$1,908.83
|
| Rate for Payer: Anthem Medicaid |
$852.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$2,057.57
|
| Rate for Payer: First Health Commercial |
$2,355.05
|
| Rate for Payer: Humana Commercial |
$2,107.15
|
| Rate for Payer: Humana KY Medicaid |
$852.53
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$861.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$869.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,859.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.49
|
| Rate for Payer: PHCS Commercial |
$2,379.84
|
| Rate for Payer: United Healthcare All Payer |
$2,181.52
|
|
|
MRA w/o fol w/cont, abd
|
Facility
|
IP
|
$2,479.00
|
|
|
Service Code
|
HCPCS C8902
|
| Hospital Charge Code |
61000088
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$2,379.84 |
| Rate for Payer: Aetna Commercial |
$1,908.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,933.62
|
| Rate for Payer: Cash Price |
$1,239.50
|
| Rate for Payer: Cigna Commercial |
$2,057.57
|
| Rate for Payer: First Health Commercial |
$2,355.05
|
| Rate for Payer: Humana Commercial |
$2,107.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,032.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,829.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$743.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,181.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,859.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$495.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$322.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$768.49
|
| Rate for Payer: PHCS Commercial |
$2,379.84
|
| Rate for Payer: United Healthcare All Payer |
$2,181.52
|
|
|
MR brain radiation planning
|
Facility
|
OP
|
$2,358.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$2,263.68 |
| Rate for Payer: Aetna Commercial |
$1,815.66
|
| Rate for Payer: Anthem Medicaid |
$810.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,957.14
|
| Rate for Payer: First Health Commercial |
$2,240.10
|
| Rate for Payer: Humana Commercial |
$2,004.30
|
| Rate for Payer: Humana KY Medicaid |
$810.92
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$819.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,740.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$827.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,075.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$730.98
|
| Rate for Payer: PHCS Commercial |
$2,263.68
|
| Rate for Payer: United Healthcare All Payer |
$2,075.04
|
|
|
MR brain radiation planning
|
Facility
|
IP
|
$2,358.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.54 |
| Max. Negotiated Rate |
$2,263.68 |
| Rate for Payer: Aetna Commercial |
$1,815.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,839.24
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cigna Commercial |
$1,957.14
|
| Rate for Payer: First Health Commercial |
$2,240.10
|
| Rate for Payer: Humana Commercial |
$2,004.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,933.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,740.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$707.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,075.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,768.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$471.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$730.98
|
| Rate for Payer: PHCS Commercial |
$2,263.68
|
| Rate for Payer: United Healthcare All Payer |
$2,075.04
|
|
|
MR brain radiation planning
|
Professional
|
Both
|
$2,358.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
61000084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Aetna Commercial |
$680.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,358.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Cash Price |
$1,179.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$1,414.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,650.60
|
| Rate for Payer: UHCCP Medicaid |
$825.30
|
|
|
MR brain radiation planning (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 76498
|
| Hospital Charge Code |
610P0084
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$680.35 |
| Rate for Payer: Aetna Commercial |
$680.35
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| 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
|
|
