|
VEIN MAPPING
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
32000295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$779.52 |
| Rate for Payer: Aetna Commercial |
$625.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$633.36
|
| Rate for Payer: Cash Price |
$406.00
|
| Rate for Payer: Cigna Commercial |
$673.96
|
| Rate for Payer: First Health Commercial |
$771.40
|
| Rate for Payer: Humana Commercial |
$690.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$599.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.56
|
| Rate for Payer: Ohio Health Group HMO |
$609.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$706.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$560.28
|
| Rate for Payer: PHCS Commercial |
$779.52
|
| Rate for Payer: United Healthcare All Payer |
$714.56
|
|
|
VEIN MAPPING(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
320P0295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Healthspan PPO |
$0.60
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
|
|
VEIN MAPPING(T
|
Facility
|
IP
|
$762.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
320T0295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.60 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.78
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
VEIN MAPPING(T
|
Facility
|
OP
|
$762.00
|
|
|
Service Code
|
HCPCS 93799
|
| Hospital Charge Code |
320T0295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.57 |
| Max. Negotiated Rate |
$731.52 |
| Rate for Payer: Aetna Commercial |
$586.74
|
| Rate for Payer: Anthem Medicaid |
$262.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$144.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$594.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$202.40
|
| Rate for Payer: CareSource Just4Me Medicare |
$195.17
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cash Price |
$381.00
|
| Rate for Payer: Cigna Commercial |
$632.46
|
| Rate for Payer: First Health Commercial |
$723.90
|
| Rate for Payer: Humana Commercial |
$647.70
|
| Rate for Payer: Humana KY Medicaid |
$262.05
|
| Rate for Payer: Humana Medicare Advantage |
$144.57
|
| Rate for Payer: Kentucky WC Medicaid |
$264.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$624.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$562.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$173.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$267.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$670.56
|
| Rate for Payer: Ohio Health Group HMO |
$571.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$609.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$525.78
|
| Rate for Payer: PHCS Commercial |
$731.52
|
| Rate for Payer: United Healthcare All Payer |
$670.56
|
|
|
VEIN X-RAY LIVER
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
32001023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,685.11 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem Medicaid |
$1,685.11
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$4,067.00
|
| Rate for Payer: First Health Commercial |
$4,655.00
|
| Rate for Payer: Humana Commercial |
$4,165.00
|
| Rate for Payer: Humana KY Medicaid |
$1,685.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,718.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
VEIN X-RAY LIVER
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
32001023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$414.26
|
| Rate for Payer: Ambetter Exchange |
$113.22
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.86
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$676.17
|
| Rate for Payer: Healthspan PPO |
$388.17
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,940.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.19
|
| Rate for Payer: UHCCP Medicaid |
$1,715.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.22
|
|
|
VEIN X-RAY LIVER
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
32001023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,470.00 |
| Max. Negotiated Rate |
$4,704.00 |
| Rate for Payer: Aetna Commercial |
$3,773.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,822.00
|
| Rate for Payer: Cash Price |
$2,450.00
|
| Rate for Payer: Cigna Commercial |
$4,067.00
|
| Rate for Payer: First Health Commercial |
$4,655.00
|
| Rate for Payer: Humana Commercial |
$4,165.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,018.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,616.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,312.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,675.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,263.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,381.00
|
| Rate for Payer: PHCS Commercial |
$4,704.00
|
| Rate for Payer: United Healthcare All Payer |
$4,312.00
|
|
|
VEIN X-RAY LIVER (P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
320P1023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$676.17 |
| Rate for Payer: Aetna Commercial |
$414.26
|
| Rate for Payer: Ambetter Exchange |
$113.22
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$113.22
|
| Rate for Payer: Buckeye Medicare Advantage |
$113.22
|
| Rate for Payer: CareSource Just4Me Medicare |
$135.86
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$676.17
|
| Rate for Payer: Healthspan PPO |
$388.17
|
| Rate for Payer: Humana Medicaid |
$389.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$72.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$113.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$113.22
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$147.19
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$113.22
|
|
|
VEIN X-RAY LIVER (T
|
Facility
|
IP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
320T1023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,818.00
|
| Rate for Payer: First Health Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial |
$3,910.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,394.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,174.00
|
| Rate for Payer: PHCS Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Payer |
$4,048.00
|
|
|
VEIN X-RAY LIVER (T
|
Facility
|
OP
|
$4,600.00
|
|
|
Service Code
|
HCPCS 75891
|
| Hospital Charge Code |
320T1023
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,581.94 |
| Max. Negotiated Rate |
$4,416.00 |
| Rate for Payer: Aetna Commercial |
$3,542.00
|
| Rate for Payer: Anthem Medicaid |
$1,581.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,588.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cash Price |
$2,300.00
|
| Rate for Payer: Cigna Commercial |
$3,818.00
|
| Rate for Payer: First Health Commercial |
$4,370.00
|
| Rate for Payer: Humana Commercial |
$3,910.00
|
| Rate for Payer: Humana KY Medicaid |
$1,581.94
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,772.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,394.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,613.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,048.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,450.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,680.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,174.00
|
| Rate for Payer: PHCS Commercial |
$4,416.00
|
| Rate for Payer: United Healthcare All Payer |
$4,048.00
|
|
|
VEIN X-RAY LIVER W/HEMODYNAM
|
Facility
|
IP
|
$4,147.00
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
76102440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,244.10 |
| Max. Negotiated Rate |
$3,981.12 |
| Rate for Payer: Aetna Commercial |
$3,193.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,234.66
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cigna Commercial |
$3,442.01
|
| Rate for Payer: First Health Commercial |
$3,939.65
|
| Rate for Payer: Humana Commercial |
$3,524.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,400.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,060.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,649.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,317.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,607.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,861.43
|
| Rate for Payer: PHCS Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare All Payer |
$3,649.36
|
|
|
VEIN X-RAY LIVER W/HEMODYNAM
|
Facility
|
OP
|
$4,147.00
|
|
|
Service Code
|
HCPCS 75885
|
| Hospital Charge Code |
76102440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,426.15 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$3,193.19
|
| Rate for Payer: Anthem Medicaid |
$1,426.15
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,234.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cash Price |
$2,073.50
|
| Rate for Payer: Cigna Commercial |
$3,442.01
|
| Rate for Payer: First Health Commercial |
$3,939.65
|
| Rate for Payer: Humana Commercial |
$3,524.95
|
| Rate for Payer: Humana KY Medicaid |
$1,426.15
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,440.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,400.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,060.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,649.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,110.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,317.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,607.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,861.43
|
| Rate for Payer: PHCS Commercial |
$3,981.12
|
| Rate for Payer: United Healthcare All Payer |
$3,649.36
|
|
|
VEIN X-RAY LIVER W/O HEMODYN
|
Facility
|
OP
|
$2,912.00
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
76102441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,001.44 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Aetna Commercial |
$2,242.24
|
| Rate for Payer: Anthem Medicaid |
$1,001.44
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,271.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cigna Commercial |
$2,416.96
|
| Rate for Payer: First Health Commercial |
$2,766.40
|
| Rate for Payer: Humana Commercial |
$2,475.20
|
| Rate for Payer: Humana KY Medicaid |
$1,001.44
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,011.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,387.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,149.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,021.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,562.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,329.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,533.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,009.28
|
| Rate for Payer: PHCS Commercial |
$2,795.52
|
| Rate for Payer: United Healthcare All Payer |
$2,562.56
|
|
|
VEIN X-RAY LIVER W/O HEMODYN
|
Facility
|
IP
|
$2,912.00
|
|
|
Service Code
|
HCPCS 75887
|
| Hospital Charge Code |
76102441
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$873.60 |
| Max. Negotiated Rate |
$2,795.52 |
| Rate for Payer: Aetna Commercial |
$2,242.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,271.36
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cigna Commercial |
$2,416.96
|
| Rate for Payer: First Health Commercial |
$2,766.40
|
| Rate for Payer: Humana Commercial |
$2,475.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,387.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,149.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$873.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,562.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,184.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,329.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,533.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,009.28
|
| Rate for Payer: PHCS Commercial |
$2,795.52
|
| Rate for Payer: United Healthcare All Payer |
$2,562.56
|
|
|
VEIN X-RAY NECK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
360P1286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$683.88 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Ambetter Exchange |
$115.44
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.53
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$115.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$153.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.07
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.44
|
|
|
VEIN X-RAY NECK
|
Facility
|
IP
|
$4,623.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
360T1286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,386.90 |
| Max. Negotiated Rate |
$4,438.08 |
| Rate for Payer: Aetna Commercial |
$3,559.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,605.94
|
| Rate for Payer: Cash Price |
$2,311.50
|
| Rate for Payer: Cigna Commercial |
$3,837.09
|
| Rate for Payer: First Health Commercial |
$4,391.85
|
| Rate for Payer: Humana Commercial |
$3,929.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,790.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,411.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,068.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,467.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,698.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,022.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,189.87
|
| Rate for Payer: PHCS Commercial |
$4,438.08
|
| Rate for Payer: United Healthcare All Payer |
$4,068.24
|
|
|
VEIN X-RAY NECK
|
Facility
|
OP
|
$4,878.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
36001286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.54 |
| Max. Negotiated Rate |
$4,682.88 |
| Rate for Payer: Aetna Commercial |
$3,756.06
|
| Rate for Payer: Anthem Medicaid |
$1,677.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,804.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna Commercial |
$4,048.74
|
| Rate for Payer: First Health Commercial |
$4,634.10
|
| Rate for Payer: Humana Commercial |
$4,146.30
|
| Rate for Payer: Humana KY Medicaid |
$1,677.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,999.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,599.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,711.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,292.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,243.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.82
|
| Rate for Payer: PHCS Commercial |
$4,682.88
|
| Rate for Payer: United Healthcare All Payer |
$4,292.64
|
|
|
VEIN X-RAY NECK
|
Facility
|
IP
|
$4,878.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
36001286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,463.40 |
| Max. Negotiated Rate |
$4,682.88 |
| Rate for Payer: Aetna Commercial |
$3,756.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,804.84
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cigna Commercial |
$4,048.74
|
| Rate for Payer: First Health Commercial |
$4,634.10
|
| Rate for Payer: Humana Commercial |
$4,146.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,999.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,599.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,463.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,292.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,658.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,243.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.82
|
| Rate for Payer: PHCS Commercial |
$4,682.88
|
| Rate for Payer: United Healthcare All Payer |
$4,292.64
|
|
|
VEIN X-RAY NECK
|
Facility
|
OP
|
$4,623.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
360T1286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,589.85 |
| Max. Negotiated Rate |
$4,438.08 |
| Rate for Payer: Aetna Commercial |
$3,559.71
|
| Rate for Payer: Anthem Medicaid |
$1,589.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,605.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Cash Price |
$2,311.50
|
| Rate for Payer: Cash Price |
$2,311.50
|
| Rate for Payer: Cigna Commercial |
$3,837.09
|
| Rate for Payer: First Health Commercial |
$4,391.85
|
| Rate for Payer: Humana Commercial |
$3,929.55
|
| Rate for Payer: Humana KY Medicaid |
$1,589.85
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,790.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,411.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,621.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,068.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,467.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,698.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,022.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,189.87
|
| Rate for Payer: PHCS Commercial |
$4,438.08
|
| Rate for Payer: United Healthcare All Payer |
$4,068.24
|
|
|
VEIN X-RAY NECK
|
Professional
|
Both
|
$4,878.00
|
|
|
Service Code
|
HCPCS 75860
|
| Hospital Charge Code |
36001286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$74.53 |
| Max. Negotiated Rate |
$2,926.80 |
| Rate for Payer: Aetna Commercial |
$420.50
|
| Rate for Payer: Ambetter Exchange |
$115.44
|
| Rate for Payer: Anthem Medicaid |
$389.16
|
| Rate for Payer: Buckeye Individual/Medicaid |
$115.44
|
| Rate for Payer: Buckeye Medicare Advantage |
$115.44
|
| Rate for Payer: CareSource Just4Me Medicare |
$138.53
|
| Rate for Payer: Cash Price |
$2,439.00
|
| Rate for Payer: Cash Price |
$2,439.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$115.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$115.44
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$396.94
|
| Rate for Payer: Molina Healthcare Passport |
$389.16
|
| Rate for Payer: Multiplan PHCS |
$2,926.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$150.07
|
| Rate for Payer: UHCCP Medicaid |
$1,707.30
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$393.05
|
| Rate for Payer: Wellcare Medicare Advantage |
$115.44
|
|
|
VELCADE 0.1MG (3.5 MG/1.4MLSDV
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem Medicaid |
$468.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Humana KY Medicaid |
$468.56
|
| Rate for Payer: Kentucky WC Medicaid |
$473.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.12
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELCADE 0.1MG (3.5 MG/1.4MLSDV
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003909
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.12
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELCADE 0.1MG(3.5 MG/3.5ML SDV
|
Facility
|
IP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.12
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELCADE 0.1MG(3.5 MG/3.5ML SDV
|
Facility
|
OP
|
$1,362.50
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25003908
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$408.75 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Commercial |
$1,049.12
|
| Rate for Payer: Anthem Medicaid |
$468.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,062.75
|
| Rate for Payer: Cash Price |
$681.25
|
| Rate for Payer: Cigna Commercial |
$1,130.88
|
| Rate for Payer: First Health Commercial |
$1,294.38
|
| Rate for Payer: Humana Commercial |
$1,158.12
|
| Rate for Payer: Humana KY Medicaid |
$468.56
|
| Rate for Payer: Kentucky WC Medicaid |
$473.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,117.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,005.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$408.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$477.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,199.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,021.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,185.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$940.12
|
| Rate for Payer: PHCS Commercial |
$1,308.00
|
| Rate for Payer: United Healthcare All Payer |
$1,199.00
|
|
|
VELTASSA 8.4 GM PACKET
|
Facility
|
OP
|
$82.10
|
|
|
Service Code
|
NDC 53436008401
|
| Hospital Charge Code |
25003567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$78.82 |
| Rate for Payer: Aetna Commercial |
$63.22
|
| Rate for Payer: Anthem Medicaid |
$28.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$64.04
|
| Rate for Payer: Cash Price |
$41.05
|
| Rate for Payer: Cigna Commercial |
$68.14
|
| Rate for Payer: First Health Commercial |
$78.00
|
| Rate for Payer: Humana Commercial |
$69.78
|
| Rate for Payer: Humana KY Medicaid |
$28.23
|
| Rate for Payer: Kentucky WC Medicaid |
$28.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$67.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$60.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$24.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$72.25
|
| Rate for Payer: Ohio Health Group HMO |
$61.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$65.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$71.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$56.65
|
| Rate for Payer: PHCS Commercial |
$78.82
|
| Rate for Payer: United Healthcare All Payer |
$72.25
|
|
