|
VENOGRAM - EXTREMITY - BILAT
|
Facility
|
OP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$229.97 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem Medicaid |
$608.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Humana KY Medicaid |
$608.36
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$614.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.39
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
VENOGRAM - EXTREMITY - BILAT
|
Facility
|
IP
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$229.97 |
| Max. Negotiated Rate |
$1,698.24 |
| Rate for Payer: Aetna Commercial |
$1,362.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.82
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$1,468.27
|
| Rate for Payer: First Health Commercial |
$1,680.55
|
| Rate for Payer: Humana Commercial |
$1,503.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.39
|
| Rate for Payer: PHCS Commercial |
$1,698.24
|
| Rate for Payer: United Healthcare All Payer |
$1,556.72
|
|
|
VENOGRAM - EXTREMITY - BILAT
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
32000166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$67.61 |
| Max. Negotiated Rate |
$1,769.00 |
| Rate for Payer: Aetna Commercial |
$221.91
|
| Rate for Payer: Anthem Medicaid |
$85.42
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,769.00
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cash Price |
$884.50
|
| Rate for Payer: Cigna Commercial |
$180.37
|
| Rate for Payer: Healthspan PPO |
$207.93
|
| Rate for Payer: Humana Medicaid |
$85.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.13
|
| Rate for Payer: Molina Healthcare Passport |
$85.42
|
| Rate for Payer: Multiplan PHCS |
$1,061.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,238.30
|
| Rate for Payer: UHCCP Medicaid |
$619.15
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$86.27
|
|
|
VENOGRAM - EXTREMITY - BILAT(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
320P0166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$67.61 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$221.91
|
| Rate for Payer: Anthem Medicaid |
$85.42
|
| 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 |
$180.37
|
| Rate for Payer: Healthspan PPO |
$207.93
|
| Rate for Payer: Humana Medicaid |
$85.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$67.61
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$87.13
|
| Rate for Payer: Molina Healthcare Passport |
$85.42
|
| 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 |
$86.27
|
|
|
VENOGRAM - EXTREMITY - BILAT(T
|
Facility
|
IP
|
$1,469.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
320T0166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$190.97 |
| Max. Negotiated Rate |
$1,410.24 |
| Rate for Payer: Aetna Commercial |
$1,131.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.82
|
| Rate for Payer: Cash Price |
$734.50
|
| Rate for Payer: Cigna Commercial |
$1,219.27
|
| Rate for Payer: First Health Commercial |
$1,395.55
|
| Rate for Payer: Humana Commercial |
$1,248.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,204.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,292.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.39
|
| Rate for Payer: PHCS Commercial |
$1,410.24
|
| Rate for Payer: United Healthcare All Payer |
$1,292.72
|
|
|
VENOGRAM - EXTREMITY - BILAT(T
|
Facility
|
OP
|
$1,469.00
|
|
|
Service Code
|
HCPCS 75822
|
| Hospital Charge Code |
320T0166
|
|
Hospital Revenue Code
|
321
|
| Min. Negotiated Rate |
$190.97 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,131.13
|
| Rate for Payer: Anthem Medicaid |
$505.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.82
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$734.50
|
| Rate for Payer: Cash Price |
$734.50
|
| Rate for Payer: Cigna Commercial |
$1,219.27
|
| Rate for Payer: First Health Commercial |
$1,395.55
|
| Rate for Payer: Humana Commercial |
$1,248.65
|
| Rate for Payer: Humana KY Medicaid |
$505.19
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$510.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,204.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,084.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$515.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,292.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.39
|
| Rate for Payer: PHCS Commercial |
$1,410.24
|
| Rate for Payer: United Healthcare All Payer |
$1,292.72
|
|
|
VENOGRAM - EXTREMITY - UNILA(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
320P0165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$180.09 |
| Rate for Payer: Aetna Commercial |
$180.09
|
| Rate for Payer: Anthem Medicaid |
$55.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$131.64
|
| Rate for Payer: Healthspan PPO |
$168.75
|
| Rate for Payer: Humana Medicaid |
$55.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.06
|
| Rate for Payer: Molina Healthcare Passport |
$55.94
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.50
|
|
|
VENOGRAM - EXTREMITY - UNILA(T
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
320T0165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.68 |
| Max. Negotiated Rate |
$1,378.56 |
| Rate for Payer: Aetna Commercial |
$1,105.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,120.08
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cigna Commercial |
$1,191.88
|
| Rate for Payer: First Health Commercial |
$1,364.20
|
| Rate for Payer: Humana Commercial |
$1,220.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,177.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$430.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,077.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$445.16
|
| Rate for Payer: PHCS Commercial |
$1,378.56
|
| Rate for Payer: United Healthcare All Payer |
$1,263.68
|
|
|
VENOGRAM - EXTREMITY - UNILA(T
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
320T0165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.68 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,105.72
|
| Rate for Payer: Anthem Medicaid |
$493.84
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,120.08
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cash Price |
$718.00
|
| Rate for Payer: Cigna Commercial |
$1,191.88
|
| Rate for Payer: First Health Commercial |
$1,364.20
|
| Rate for Payer: Humana Commercial |
$1,220.60
|
| Rate for Payer: Humana KY Medicaid |
$493.84
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$498.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,177.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,059.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$503.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,263.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,077.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$287.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$186.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$445.16
|
| Rate for Payer: PHCS Commercial |
$1,378.56
|
| Rate for Payer: United Healthcare All Payer |
$1,263.68
|
|
|
VENOGRAM - EXTREMITY - UNILAT
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.58 |
| Max. Negotiated Rate |
$1,938.90 |
| Rate for Payer: Aetna Commercial |
$1,205.82
|
| Rate for Payer: Anthem Medicaid |
$538.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,384.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.48
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,938.90
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,869.66
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$1,299.78
|
| Rate for Payer: First Health Commercial |
$1,487.70
|
| Rate for Payer: Humana Commercial |
$1,331.10
|
| Rate for Payer: Humana KY Medicaid |
$538.55
|
| Rate for Payer: Humana Medicare Advantage |
$1,384.93
|
| Rate for Payer: Kentucky WC Medicaid |
$544.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.46
|
| Rate for Payer: PHCS Commercial |
$1,503.36
|
| Rate for Payer: United Healthcare All Payer |
$1,378.08
|
|
|
VENOGRAM - EXTREMITY - UNILAT
|
Professional
|
Both
|
$1,566.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$1,566.00 |
| Rate for Payer: Aetna Commercial |
$180.09
|
| Rate for Payer: Anthem Medicaid |
$55.94
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,566.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$131.64
|
| Rate for Payer: Healthspan PPO |
$168.75
|
| Rate for Payer: Humana Medicaid |
$55.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$44.98
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$57.06
|
| Rate for Payer: Molina Healthcare Passport |
$55.94
|
| Rate for Payer: Multiplan PHCS |
$939.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,096.20
|
| Rate for Payer: UHCCP Medicaid |
$548.10
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$56.50
|
|
|
VENOGRAM - EXTREMITY - UNILAT
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
HCPCS 75820
|
| Hospital Charge Code |
32000165
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.58 |
| Max. Negotiated Rate |
$1,503.36 |
| Rate for Payer: Aetna Commercial |
$1,205.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.48
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$1,299.78
|
| Rate for Payer: First Health Commercial |
$1,487.70
|
| Rate for Payer: Humana Commercial |
$1,331.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.46
|
| Rate for Payer: PHCS Commercial |
$1,503.36
|
| Rate for Payer: United Healthcare All Payer |
$1,378.08
|
|
|
VENOGRAPHY ADRENAL UNIL SELEC
|
Facility
|
IP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75840
|
| Hospital Charge Code |
32000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
VENOGRAPHY ADRENAL UNIL SELEC
|
Facility
|
OP
|
$4,467.00
|
|
|
Service Code
|
HCPCS 75840
|
| Hospital Charge Code |
32000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$580.71 |
| Max. Negotiated Rate |
$4,288.32 |
| Rate for Payer: Aetna Commercial |
$3,439.59
|
| Rate for Payer: Anthem Medicaid |
$1,536.20
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.26
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cash Price |
$2,233.50
|
| Rate for Payer: Cigna Commercial |
$3,707.61
|
| Rate for Payer: First Health Commercial |
$4,243.65
|
| Rate for Payer: Humana Commercial |
$3,796.95
|
| Rate for Payer: Humana KY Medicaid |
$1,536.20
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,662.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,930.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.77
|
| Rate for Payer: PHCS Commercial |
$4,288.32
|
| Rate for Payer: United Healthcare All Payer |
$3,930.96
|
|
|
VENOUS THROMBOSIS IMAGING
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
76102743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$438.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.60
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
VENOUS THROMBOSIS IMAGING
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
76102743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$1,460.00 |
| Rate for Payer: Aetna Commercial |
$281.87
|
| Rate for Payer: Anthem Medicaid |
$105.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,460.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$233.44
|
| Rate for Payer: Healthspan PPO |
$281.73
|
| Rate for Payer: Humana Medicaid |
$105.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.29
|
| Rate for Payer: Molina Healthcare Passport |
$105.19
|
| Rate for Payer: Multiplan PHCS |
$876.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,022.00
|
| Rate for Payer: UHCCP Medicaid |
$511.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.24
|
|
|
VENOUS THROMBOSIS IMAGING
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
76102743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$189.80 |
| Max. Negotiated Rate |
$1,401.60 |
| Rate for Payer: Aetna Commercial |
$1,124.20
|
| Rate for Payer: Anthem Medicaid |
$502.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,138.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cash Price |
$730.00
|
| Rate for Payer: Cigna Commercial |
$1,211.80
|
| Rate for Payer: First Health Commercial |
$1,387.00
|
| Rate for Payer: Humana Commercial |
$1,241.00
|
| Rate for Payer: Humana KY Medicaid |
$502.09
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$507.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,197.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,077.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$512.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,284.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,095.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$292.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$189.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$452.60
|
| Rate for Payer: PHCS Commercial |
$1,401.60
|
| Rate for Payer: United Healthcare All Payer |
$1,284.80
|
|
|
VENOUS THROMBOSIS IMAGING(P
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
761P2743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$281.87 |
| Rate for Payer: Aetna Commercial |
$281.87
|
| Rate for Payer: Anthem Medicaid |
$105.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$130.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cigna Commercial |
$233.44
|
| Rate for Payer: Healthspan PPO |
$281.73
|
| Rate for Payer: Humana Medicaid |
$105.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$43.05
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$107.29
|
| Rate for Payer: Molina Healthcare Passport |
$105.19
|
| Rate for Payer: Multiplan PHCS |
$78.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$91.00
|
| Rate for Payer: UHCCP Medicaid |
$45.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$106.24
|
|
|
VENOUS THROMBOSIS IMAGING(T
|
Facility
|
OP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
761T2743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem Medicaid |
$457.39
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$467.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$654.36
|
| Rate for Payer: CareSource Just4Me Medicare |
$630.99
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Humana KY Medicaid |
$457.39
|
| Rate for Payer: Humana Medicare Advantage |
$467.40
|
| Rate for Payer: Kentucky WC Medicaid |
$462.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$466.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
VENOUS THROMBOSIS IMAGING(T
|
Facility
|
IP
|
$1,330.00
|
|
|
Service Code
|
HCPCS 78457
|
| Hospital Charge Code |
761T2743
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,024.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,037.40
|
| Rate for Payer: Cash Price |
$665.00
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: First Health Commercial |
$1,263.50
|
| Rate for Payer: Humana Commercial |
$1,130.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,090.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$981.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,170.40
|
| Rate for Payer: Ohio Health Group HMO |
$997.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$266.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$172.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$412.30
|
| Rate for Payer: PHCS Commercial |
$1,276.80
|
| Rate for Payer: United Healthcare All Payer |
$1,170.40
|
|
|
VENOUS WALL-STENT 18*60*75
|
Facility
|
IP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
VENOUS WALL-STENT 18*60*75
|
Facility
|
OP
|
$5,280.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
27000127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$5,068.80 |
| Rate for Payer: Aetna Commercial |
$4,065.60
|
| Rate for Payer: Anthem Medicaid |
$1,815.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,118.40
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cigna Commercial |
$4,382.40
|
| Rate for Payer: First Health Commercial |
$5,016.00
|
| Rate for Payer: Humana Commercial |
$4,488.00
|
| Rate for Payer: Humana KY Medicaid |
$1,815.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,329.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,896.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,584.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,852.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,646.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,960.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,056.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,636.80
|
| Rate for Payer: PHCS Commercial |
$5,068.80
|
| Rate for Payer: United Healthcare All Payer |
$4,646.40
|
|
|
VENO VENOUS SINUS S&I
|
Facility
|
OP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
32000172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$609.96 |
| Max. Negotiated Rate |
$4,504.32 |
| Rate for Payer: Aetna Commercial |
$3,612.84
|
| Rate for Payer: Anthem Medicaid |
$1,613.58
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,659.76
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,894.36
|
| Rate for Payer: First Health Commercial |
$4,457.40
|
| Rate for Payer: Humana Commercial |
$3,988.20
|
| Rate for Payer: Humana KY Medicaid |
$1,613.58
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,630.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,847.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,462.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,645.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,128.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,454.52
|
| Rate for Payer: PHCS Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare All Payer |
$4,128.96
|
|
|
VENO VENOUS SINUS S&I
|
Facility
|
IP
|
$4,692.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
32000172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$609.96 |
| Max. Negotiated Rate |
$4,504.32 |
| Rate for Payer: Aetna Commercial |
$3,612.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,659.76
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$3,894.36
|
| Rate for Payer: First Health Commercial |
$4,457.40
|
| Rate for Payer: Humana Commercial |
$3,988.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,847.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,462.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,407.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,128.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,519.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,454.52
|
| Rate for Payer: PHCS Commercial |
$4,504.32
|
| Rate for Payer: United Healthcare All Payer |
$4,128.96
|
|
|
VENO VENOUS SINUS S&I
|
Professional
|
Both
|
$4,692.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
32000172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$4,692.00 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,692.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cash Price |
$2,346.00
|
| Rate for Payer: Cigna Commercial |
$683.88
|
| Rate for Payer: Healthspan PPO |
$394.02
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.53
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,815.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,284.40
|
| Rate for Payer: UHCCP Medicaid |
$1,642.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
|
