|
MR ANGIOGRAPH NECK W/O&W/DYE
|
Facility
|
IP
|
$4,459.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
61000007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,337.70 |
| Max. Negotiated Rate |
$4,280.64 |
| Rate for Payer: Aetna Commercial |
$3,433.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,478.02
|
| Rate for Payer: Cash Price |
$2,229.50
|
| Rate for Payer: Cigna Commercial |
$3,700.97
|
| Rate for Payer: First Health Commercial |
$4,236.05
|
| Rate for Payer: Humana Commercial |
$3,790.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,656.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,290.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,923.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,344.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,567.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,879.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.71
|
| Rate for Payer: PHCS Commercial |
$4,280.64
|
| Rate for Payer: United Healthcare All Payer |
$3,923.92
|
|
|
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: Ambetter Exchange |
$315.66
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.79
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$315.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.66
|
| 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 |
$410.36
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.66
|
|
|
MR ANGIOGRAPH NECK W/O&W/DY(T
|
Facility
|
OP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
610T0007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,088.64 |
| Rate for Payer: Aetna Commercial |
$3,279.43
|
| Rate for Payer: Anthem Medicaid |
$1,464.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cigna Commercial |
$3,534.97
|
| Rate for Payer: First Health Commercial |
$4,046.05
|
| Rate for Payer: Humana Commercial |
$3,620.15
|
| Rate for Payer: Humana KY Medicaid |
$1,464.67
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,705.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.71
|
| Rate for Payer: PHCS Commercial |
$4,088.64
|
| Rate for Payer: United Healthcare All Payer |
$3,747.92
|
|
|
MR ANGIOGRAPH NECK W/O&W/DY(T
|
Facility
|
IP
|
$4,259.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
610T0007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,277.70 |
| Max. Negotiated Rate |
$4,088.64 |
| Rate for Payer: Aetna Commercial |
$3,279.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.02
|
| Rate for Payer: Cash Price |
$2,129.50
|
| Rate for Payer: Cigna Commercial |
$3,534.97
|
| Rate for Payer: First Health Commercial |
$4,046.05
|
| Rate for Payer: Humana Commercial |
$3,620.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,407.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,705.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,938.71
|
| Rate for Payer: PHCS Commercial |
$4,088.64
|
| Rate for Payer: United Healthcare All Payer |
$3,747.92
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE
|
Professional
|
Both
|
$3,802.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$2,281.20 |
| Rate for Payer: Aetna Commercial |
$619.56
|
| Rate for Payer: Ambetter Exchange |
$197.08
|
| Rate for Payer: Anthem Medicaid |
$411.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.50
|
| Rate for Payer: Cash Price |
$1,901.00
|
| Rate for Payer: Cash Price |
$1,901.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$197.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.08
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$419.74
|
| Rate for Payer: Molina Healthcare Passport |
$411.51
|
| Rate for Payer: Multiplan PHCS |
$2,281.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.20
|
| Rate for Payer: UHCCP Medicaid |
$1,330.70
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.08
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE
|
Facility
|
IP
|
$3,802.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,140.60 |
| Max. Negotiated Rate |
$3,649.92 |
| Rate for Payer: Aetna Commercial |
$2,927.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,965.56
|
| Rate for Payer: Cash Price |
$1,901.00
|
| Rate for Payer: Cigna Commercial |
$3,155.66
|
| Rate for Payer: First Health Commercial |
$3,611.90
|
| Rate for Payer: Humana Commercial |
$3,231.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,117.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,805.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,345.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,851.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,041.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,307.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,623.38
|
| Rate for Payer: PHCS Commercial |
$3,649.92
|
| Rate for Payer: United Healthcare All Payer |
$3,345.76
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
61000005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,649.92 |
| Rate for Payer: Aetna Commercial |
$2,927.54
|
| Rate for Payer: Anthem Medicaid |
$1,307.51
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,965.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,901.00
|
| Rate for Payer: Cash Price |
$1,901.00
|
| Rate for Payer: Cigna Commercial |
$3,155.66
|
| Rate for Payer: First Health Commercial |
$3,611.90
|
| Rate for Payer: Humana Commercial |
$3,231.70
|
| Rate for Payer: Humana KY Medicaid |
$1,307.51
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,320.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,117.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,805.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,333.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,345.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,851.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,041.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,307.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,623.38
|
| Rate for Payer: PHCS Commercial |
$3,649.92
|
| Rate for Payer: United Healthcare All Payer |
$3,345.76
|
|
|
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: Ambetter Exchange |
$197.08
|
| Rate for Payer: Anthem Medicaid |
$411.51
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.08
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.08
|
| Rate for Payer: CareSource Just4Me Medicare |
$236.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$197.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.08
|
| 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 |
$256.20
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$415.63
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.08
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
610T0005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem Medicaid |
$1,255.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Humana KY Medicaid |
$1,255.92
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MR ANGIOGRAPHY HEAD W/O DYE(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 70544
|
| Hospital Charge Code |
610T0005
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MR ANGIOGRAPHY NECK W/DYE
|
Facility
|
IP
|
$3,490.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
61000052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,047.00 |
| Max. Negotiated Rate |
$3,350.40 |
| Rate for Payer: Aetna Commercial |
$2,687.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,722.20
|
| Rate for Payer: Cash Price |
$1,745.00
|
| Rate for Payer: Cigna Commercial |
$2,896.70
|
| Rate for Payer: First Health Commercial |
$3,315.50
|
| Rate for Payer: Humana Commercial |
$2,966.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,861.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,575.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,071.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,617.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,036.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,408.10
|
| Rate for Payer: PHCS Commercial |
$3,350.40
|
| Rate for Payer: United Healthcare All Payer |
$3,071.20
|
|
|
MR ANGIOGRAPHY NECK W/DYE
|
Professional
|
Both
|
$3,490.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
61000052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$2,094.00 |
| Rate for Payer: Aetna Commercial |
$738.54
|
| Rate for Payer: Ambetter Exchange |
$225.72
|
| Rate for Payer: Anthem Medicaid |
$346.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$225.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$270.86
|
| Rate for Payer: Cash Price |
$1,745.00
|
| Rate for Payer: Cash Price |
$1,745.00
|
| Rate for Payer: Cigna Commercial |
$797.59
|
| Rate for Payer: Healthspan PPO |
$507.49
|
| Rate for Payer: Humana Medicaid |
$346.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$225.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$353.86
|
| Rate for Payer: Molina Healthcare Passport |
$346.92
|
| Rate for Payer: Multiplan PHCS |
$2,094.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$293.44
|
| Rate for Payer: UHCCP Medicaid |
$1,221.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$225.72
|
|
|
MR ANGIOGRAPHY NECK W/DYE
|
Facility
|
OP
|
$3,490.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
61000052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,350.40 |
| Rate for Payer: Aetna Commercial |
$2,687.30
|
| Rate for Payer: Anthem Medicaid |
$1,200.21
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,722.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,745.00
|
| Rate for Payer: Cash Price |
$1,745.00
|
| Rate for Payer: Cigna Commercial |
$2,896.70
|
| Rate for Payer: First Health Commercial |
$3,315.50
|
| Rate for Payer: Humana Commercial |
$2,966.50
|
| Rate for Payer: Humana KY Medicaid |
$1,200.21
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,861.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,575.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,071.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,617.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,792.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,036.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,408.10
|
| Rate for Payer: PHCS Commercial |
$3,350.40
|
| Rate for Payer: United Healthcare All Payer |
$3,071.20
|
|
|
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: Ambetter Exchange |
$225.72
|
| Rate for Payer: Anthem Medicaid |
$346.92
|
| Rate for Payer: Buckeye Individual/Medicaid |
$225.72
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.72
|
| Rate for Payer: CareSource Just4Me Medicare |
$270.86
|
| 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 |
$507.49
|
| Rate for Payer: Humana Medicaid |
$346.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$76.19
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$225.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$225.72
|
| 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 |
$293.44
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$350.39
|
| Rate for Payer: Wellcare Medicare Advantage |
$225.72
|
|
|
MR ANGIOGRAPHY NECK W/DYE(T
|
Facility
|
IP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
610T0052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,002.00 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.60
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
MR ANGIOGRAPHY NECK W/DYE(T
|
Facility
|
OP
|
$3,340.00
|
|
|
Service Code
|
HCPCS 70548
|
| Hospital Charge Code |
610T0052
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,206.40 |
| Rate for Payer: Aetna Commercial |
$2,571.80
|
| Rate for Payer: Anthem Medicaid |
$1,148.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.20
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cash Price |
$1,670.00
|
| Rate for Payer: Cigna Commercial |
$2,772.20
|
| Rate for Payer: First Health Commercial |
$3,173.00
|
| Rate for Payer: Humana Commercial |
$2,839.00
|
| Rate for Payer: Humana KY Medicaid |
$1,148.63
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,171.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,939.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.60
|
| Rate for Payer: PHCS Commercial |
$3,206.40
|
| Rate for Payer: United Healthcare All Payer |
$2,939.20
|
|
|
MR ANGIOGRAPHY NECK W/O DYE
|
Facility
|
IP
|
$4,092.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,227.60 |
| Max. Negotiated Rate |
$3,928.32 |
| Rate for Payer: Aetna Commercial |
$3,150.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,191.76
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$3,396.36
|
| Rate for Payer: First Health Commercial |
$3,887.40
|
| Rate for Payer: Humana Commercial |
$3,478.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,355.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,019.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,600.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,069.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.48
|
| Rate for Payer: PHCS Commercial |
$3,928.32
|
| Rate for Payer: United Healthcare All Payer |
$3,600.96
|
|
|
MR ANGIOGRAPHY NECK W/O DYE
|
Professional
|
Both
|
$4,092.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$76.19 |
| Max. Negotiated Rate |
$2,455.20 |
| Rate for Payer: Aetna Commercial |
$619.74
|
| Rate for Payer: Ambetter Exchange |
$197.67
|
| Rate for Payer: Anthem Medicaid |
$410.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.20
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$197.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$418.70
|
| Rate for Payer: Molina Healthcare Passport |
$410.49
|
| Rate for Payer: Multiplan PHCS |
$2,455.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$256.97
|
| Rate for Payer: UHCCP Medicaid |
$1,432.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.67
|
|
|
MR ANGIOGRAPHY NECK W/O DYE
|
Facility
|
OP
|
$4,092.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
61000006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,928.32 |
| Rate for Payer: Aetna Commercial |
$3,150.84
|
| Rate for Payer: Anthem Medicaid |
$1,407.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,191.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$3,396.36
|
| Rate for Payer: First Health Commercial |
$3,887.40
|
| Rate for Payer: Humana Commercial |
$3,478.20
|
| Rate for Payer: Humana KY Medicaid |
$1,407.24
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,421.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,355.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,019.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,435.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,600.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,069.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,273.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,560.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,823.48
|
| Rate for Payer: PHCS Commercial |
$3,928.32
|
| Rate for Payer: United Healthcare All Payer |
$3,600.96
|
|
|
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: Ambetter Exchange |
$197.67
|
| Rate for Payer: Anthem Medicaid |
$410.49
|
| Rate for Payer: Buckeye Individual/Medicaid |
$197.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$197.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$237.20
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$197.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.67
|
| 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 |
$256.97
|
| Rate for Payer: UHCCP Medicaid |
$154.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$414.59
|
| Rate for Payer: Wellcare Medicare Advantage |
$197.67
|
|
|
MR ANGIOGRAPHY NECK W/O DYE(T
|
Facility
|
IP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
610T0006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
MR ANGIOGRAPHY NECK W/O DYE(T
|
Facility
|
OP
|
$3,652.00
|
|
|
Service Code
|
HCPCS 70547
|
| Hospital Charge Code |
610T0006
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$223.34 |
| Max. Negotiated Rate |
$3,505.92 |
| Rate for Payer: Aetna Commercial |
$2,812.04
|
| Rate for Payer: Anthem Medicaid |
$1,255.92
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$223.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$312.68
|
| Rate for Payer: CareSource Just4Me Medicare |
$301.51
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cash Price |
$1,826.00
|
| Rate for Payer: Cigna Commercial |
$3,031.16
|
| Rate for Payer: First Health Commercial |
$3,469.40
|
| Rate for Payer: Humana Commercial |
$3,104.20
|
| Rate for Payer: Humana KY Medicaid |
$1,255.92
|
| Rate for Payer: Humana Medicare Advantage |
$223.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$268.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,921.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,519.88
|
| Rate for Payer: PHCS Commercial |
$3,505.92
|
| Rate for Payer: United Healthcare All Payer |
$3,213.76
|
|
|
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 |
$1,249.20 |
| 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 |
$3,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,622.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.16
|
| 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
|
Facility
|
OP
|
$4,164.00
|
|
|
Service Code
|
HCPCS 72198
|
| Hospital Charge Code |
61000026
|
|
Hospital Revenue Code
|
618
|
| Min. Negotiated Rate |
$1,249.20 |
| 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 |
$3,331.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,622.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.16
|
| 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
|
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 |
$2,498.40 |
| Rate for Payer: Aetna Commercial |
$788.34
|
| Rate for Payer: Ambetter Exchange |
$309.25
|
| Rate for Payer: Anthem Medicaid |
$377.54
|
| Rate for Payer: Buckeye Individual/Medicaid |
$309.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$309.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$371.10
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$309.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$309.25
|
| 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 |
$402.02
|
| Rate for Payer: UHCCP Medicaid |
$1,457.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$381.32
|
| Rate for Payer: Wellcare Medicare Advantage |
$309.25
|
|
