|
CT ANGIO ABDOMINAL ARTERIES
|
Facility
|
IP
|
$3,403.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
35000013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$442.39 |
| Max. Negotiated Rate |
$3,266.88 |
| Rate for Payer: Aetna Commercial |
$2,620.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,654.34
|
| Rate for Payer: Cash Price |
$1,701.50
|
| Rate for Payer: Cigna Commercial |
$2,824.49
|
| Rate for Payer: First Health Commercial |
$3,232.85
|
| Rate for Payer: Humana Commercial |
$2,892.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,790.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,511.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,020.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,994.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,552.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,054.93
|
| Rate for Payer: PHCS Commercial |
$3,266.88
|
| Rate for Payer: United Healthcare All Payer |
$2,994.64
|
|
|
CT ANGIO ABDOMINAL ARTERIES(P
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
350P0013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$1,013.89 |
| Rate for Payer: Aetna Commercial |
$724.71
|
| Rate for Payer: Anthem Medicaid |
$300.86
|
| Rate for Payer: Buckeye Medicare Advantage |
$275.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna Commercial |
$1,013.89
|
| Rate for Payer: Healthspan PPO |
$679.06
|
| Rate for Payer: Humana Medicaid |
$300.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$153.39
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$306.88
|
| Rate for Payer: Molina Healthcare Passport |
$300.86
|
| Rate for Payer: Multiplan PHCS |
$165.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$192.50
|
| Rate for Payer: UHCCP Medicaid |
$96.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$303.87
|
|
|
CT ANGIO ABDOMINAL ARTERIES(T
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
350T0013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem Medicaid |
$1,075.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Humana KY Medicaid |
$1,075.72
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
CT ANGIO ABDOMINAL ARTERIES(T
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 75635
|
| Hospital Charge Code |
350T0013
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$406.64 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
CT ANGIO ABDOM W/O & W/DYE
|
Facility
|
IP
|
$3,353.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$435.89 |
| Max. Negotiated Rate |
$3,218.88 |
| Rate for Payer: Aetna Commercial |
$2,581.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.34
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cigna Commercial |
$2,782.99
|
| Rate for Payer: First Health Commercial |
$3,185.35
|
| Rate for Payer: Humana Commercial |
$2,850.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,749.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,474.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,950.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,514.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,039.43
|
| Rate for Payer: PHCS Commercial |
$3,218.88
|
| Rate for Payer: United Healthcare All Payer |
$2,950.64
|
|
|
CT ANGIO ABDOM W/O & W/DYE
|
Professional
|
Both
|
$3,353.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$121.70 |
| Max. Negotiated Rate |
$3,353.00 |
| Rate for Payer: Aetna Commercial |
$681.93
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,353.00
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cigna Commercial |
$810.80
|
| Rate for Payer: Healthspan PPO |
$468.59
|
| Rate for Payer: Humana Medicaid |
$273.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.25
|
| Rate for Payer: Molina Healthcare Passport |
$273.77
|
| Rate for Payer: Multiplan PHCS |
$2,011.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,347.10
|
| Rate for Payer: UHCCP Medicaid |
$1,173.55
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
|
|
CT ANGIO ABDOM W/O & W/DYE
|
Facility
|
OP
|
$3,353.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
35000007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,218.88 |
| Rate for Payer: Aetna Commercial |
$2,581.81
|
| Rate for Payer: Anthem Medicaid |
$1,153.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.34
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cash Price |
$1,676.50
|
| Rate for Payer: Cigna Commercial |
$2,782.99
|
| Rate for Payer: First Health Commercial |
$3,185.35
|
| Rate for Payer: Humana Commercial |
$2,850.05
|
| Rate for Payer: Humana KY Medicaid |
$1,153.10
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,164.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,749.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,474.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,176.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,950.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,514.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$670.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,039.43
|
| Rate for Payer: PHCS Commercial |
$3,218.88
|
| Rate for Payer: United Healthcare All Payer |
$2,950.64
|
|
|
CT ANGIO ABDOM W/O & W/DYE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
350P0007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$810.80 |
| Rate for Payer: Aetna Commercial |
$681.93
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$810.80
|
| Rate for Payer: Healthspan PPO |
$468.59
|
| Rate for Payer: Humana Medicaid |
$273.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.25
|
| Rate for Payer: Molina Healthcare Passport |
$273.77
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
|
|
CT ANGIO ABDOM W/O & W/DYE(T
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
350T0007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$406.64 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
CT ANGIO ABDOM W/O & W/DYE(T
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 74175
|
| Hospital Charge Code |
350T0007
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,002.88 |
| Rate for Payer: Aetna Commercial |
$2,408.56
|
| Rate for Payer: Anthem Medicaid |
$1,075.72
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.84
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cash Price |
$1,564.00
|
| Rate for Payer: Cigna Commercial |
$2,596.24
|
| Rate for Payer: First Health Commercial |
$2,971.60
|
| Rate for Payer: Humana Commercial |
$2,658.80
|
| Rate for Payer: Humana KY Medicaid |
$1,075.72
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,346.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.68
|
| Rate for Payer: PHCS Commercial |
$3,002.88
|
| Rate for Payer: United Healthcare All Payer |
$2,752.64
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE
|
Facility
|
OP
|
$6,483.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$6,223.68 |
| Rate for Payer: Aetna Commercial |
$4,991.91
|
| Rate for Payer: Anthem Medicaid |
$2,229.50
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,056.74
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cigna Commercial |
$5,380.89
|
| Rate for Payer: First Health Commercial |
$6,158.85
|
| Rate for Payer: Humana Commercial |
$5,510.55
|
| Rate for Payer: Humana KY Medicaid |
$2,229.50
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,252.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,316.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,784.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,274.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,705.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,862.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,296.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,009.73
|
| Rate for Payer: PHCS Commercial |
$6,223.68
|
| Rate for Payer: United Healthcare All Payer |
$5,705.04
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE
|
Facility
|
IP
|
$6,483.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$842.79 |
| Max. Negotiated Rate |
$6,223.68 |
| Rate for Payer: Aetna Commercial |
$4,991.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,056.74
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cigna Commercial |
$5,380.89
|
| Rate for Payer: First Health Commercial |
$6,158.85
|
| Rate for Payer: Humana Commercial |
$5,510.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,316.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,784.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,944.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,705.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,862.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,296.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$842.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,009.73
|
| Rate for Payer: PHCS Commercial |
$6,223.68
|
| Rate for Payer: United Healthcare All Payer |
$5,705.04
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE
|
Professional
|
Both
|
$6,483.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
35000006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$133.71 |
| Max. Negotiated Rate |
$6,483.00 |
| Rate for Payer: Anthem Medicaid |
$434.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$6,483.00
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cigna Commercial |
$920.51
|
| Rate for Payer: Healthspan PPO |
$420.86
|
| Rate for Payer: Humana Medicaid |
$434.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.51
|
| Rate for Payer: Molina Healthcare Passport |
$434.81
|
| Rate for Payer: Multiplan PHCS |
$3,889.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$4,538.10
|
| Rate for Payer: UHCCP Medicaid |
$2,269.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$439.16
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
350P0006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$920.51 |
| Rate for Payer: Anthem Medicaid |
$434.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$920.51
|
| Rate for Payer: Healthspan PPO |
$420.86
|
| Rate for Payer: Humana Medicaid |
$434.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$133.71
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$443.51
|
| Rate for Payer: Molina Healthcare Passport |
$434.81
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$439.16
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE(T
|
Facility
|
IP
|
$6,258.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
350T0006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$813.54 |
| Max. Negotiated Rate |
$6,007.68 |
| Rate for Payer: Aetna Commercial |
$4,818.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,881.24
|
| Rate for Payer: Cash Price |
$3,129.00
|
| Rate for Payer: Cigna Commercial |
$5,194.14
|
| Rate for Payer: First Health Commercial |
$5,945.10
|
| Rate for Payer: Humana Commercial |
$5,319.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,131.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,618.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,877.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,507.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,693.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,939.98
|
| Rate for Payer: PHCS Commercial |
$6,007.68
|
| Rate for Payer: United Healthcare All Payer |
$5,507.04
|
|
|
CT ANGIO ABD&PELV W/O&W/DYE(T
|
Facility
|
OP
|
$6,258.00
|
|
|
Service Code
|
HCPCS 74174
|
| Hospital Charge Code |
350T0006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$6,007.68 |
| Rate for Payer: Aetna Commercial |
$4,818.66
|
| Rate for Payer: Anthem Medicaid |
$2,152.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,881.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$3,129.00
|
| Rate for Payer: Cash Price |
$3,129.00
|
| Rate for Payer: Cigna Commercial |
$5,194.14
|
| Rate for Payer: First Health Commercial |
$5,945.10
|
| Rate for Payer: Humana Commercial |
$5,319.30
|
| Rate for Payer: Humana KY Medicaid |
$2,152.13
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,174.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,131.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,618.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,195.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,507.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,693.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$813.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,939.98
|
| Rate for Payer: PHCS Commercial |
$6,007.68
|
| Rate for Payer: United Healthcare All Payer |
$5,507.04
|
|
|
CT ANGIOGRAPH PELV W/O&W/DYE
|
Facility
|
OP
|
$3,247.00
|
|
|
Service Code
|
HCPCS 72191
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,117.12 |
| Rate for Payer: Aetna Commercial |
$2,500.19
|
| Rate for Payer: Anthem Medicaid |
$1,116.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cigna Commercial |
$2,695.01
|
| Rate for Payer: First Health Commercial |
$3,084.65
|
| Rate for Payer: Humana Commercial |
$2,759.95
|
| Rate for Payer: Humana KY Medicaid |
$1,116.64
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.57
|
| Rate for Payer: PHCS Commercial |
$3,117.12
|
| Rate for Payer: United Healthcare All Payer |
$2,857.36
|
|
|
CT ANGIOGRAPH PELV W/O&W/DYE
|
Facility
|
IP
|
$3,247.00
|
|
|
Service Code
|
HCPCS 72191
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$422.11 |
| Max. Negotiated Rate |
$3,117.12 |
| Rate for Payer: Aetna Commercial |
$2,500.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.66
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cigna Commercial |
$2,695.01
|
| Rate for Payer: First Health Commercial |
$3,084.65
|
| Rate for Payer: Humana Commercial |
$2,759.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.57
|
| Rate for Payer: PHCS Commercial |
$3,117.12
|
| Rate for Payer: United Healthcare All Payer |
$2,857.36
|
|
|
CT ANGIOGRAPH PELV W/O&W/DYE
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 72191
|
| Hospital Charge Code |
35000004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$116.14 |
| Max. Negotiated Rate |
$3,247.00 |
| Rate for Payer: Aetna Commercial |
$674.94
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,247.00
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cigna Commercial |
$792.87
|
| Rate for Payer: Healthspan PPO |
$463.78
|
| Rate for Payer: Humana Medicaid |
$273.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.25
|
| Rate for Payer: Molina Healthcare Passport |
$273.77
|
| Rate for Payer: Multiplan PHCS |
$1,948.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,272.90
|
| Rate for Payer: UHCCP Medicaid |
$1,136.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
|
|
CT ANGIOGRAPH PELV W/O&W/DY(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 72191
|
| Hospital Charge Code |
350P0004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$792.87 |
| Rate for Payer: Aetna Commercial |
$674.94
|
| Rate for Payer: Anthem Medicaid |
$273.77
|
| Rate for Payer: Buckeye Medicare Advantage |
$225.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$792.87
|
| Rate for Payer: Healthspan PPO |
$463.78
|
| Rate for Payer: Humana Medicaid |
$273.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$116.14
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$279.25
|
| Rate for Payer: Molina Healthcare Passport |
$273.77
|
| Rate for Payer: Multiplan PHCS |
$135.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$157.50
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$276.51
|
|
|
CT ANGIOGRAPH PELV W/O&W/DY(T
|
Facility
|
OP
|
$3,022.00
|
|
|
Service Code
|
HCPCS 72191
|
| Hospital Charge Code |
350T0004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$2,901.12 |
| Rate for Payer: Aetna Commercial |
$2,326.94
|
| Rate for Payer: Anthem Medicaid |
$1,039.27
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,357.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,511.00
|
| Rate for Payer: Cash Price |
$1,511.00
|
| Rate for Payer: Cigna Commercial |
$2,508.26
|
| Rate for Payer: First Health Commercial |
$2,870.90
|
| Rate for Payer: Humana Commercial |
$2,568.70
|
| Rate for Payer: Humana KY Medicaid |
$1,039.27
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,049.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,478.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,230.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,060.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,659.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,266.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$392.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$936.82
|
| Rate for Payer: PHCS Commercial |
$2,901.12
|
| Rate for Payer: United Healthcare All Payer |
$2,659.36
|
|
|
CT ANGIOGRAPH PELV W/O&W/DY(T
|
Facility
|
IP
|
$3,022.00
|
|
|
Service Code
|
HCPCS 72191
|
| Hospital Charge Code |
350T0004
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$392.86 |
| Max. Negotiated Rate |
$2,901.12 |
| Rate for Payer: Aetna Commercial |
$2,326.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,357.16
|
| Rate for Payer: Cash Price |
$1,511.00
|
| Rate for Payer: Cigna Commercial |
$2,508.26
|
| Rate for Payer: First Health Commercial |
$2,870.90
|
| Rate for Payer: Humana Commercial |
$2,568.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,478.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,230.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,659.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,266.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$604.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$392.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$936.82
|
| Rate for Payer: PHCS Commercial |
$2,901.12
|
| Rate for Payer: United Healthcare All Payer |
$2,659.36
|
|
|
CT ANGIOGRAPHY CHEST
|
Facility
|
IP
|
$3,247.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$422.11 |
| Max. Negotiated Rate |
$3,117.12 |
| Rate for Payer: Aetna Commercial |
$2,500.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.66
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cigna Commercial |
$2,695.01
|
| Rate for Payer: First Health Commercial |
$3,084.65
|
| Rate for Payer: Humana Commercial |
$2,759.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.57
|
| Rate for Payer: PHCS Commercial |
$3,117.12
|
| Rate for Payer: United Healthcare All Payer |
$2,857.36
|
|
|
CT ANGIOGRAPHY CHEST
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$3,247.00 |
| Rate for Payer: Aetna Commercial |
$683.97
|
| Rate for Payer: Anthem Medicaid |
$282.81
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,247.00
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cigna Commercial |
$820.27
|
| Rate for Payer: Healthspan PPO |
$469.99
|
| Rate for Payer: Humana Medicaid |
$282.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$122.45
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.47
|
| Rate for Payer: Molina Healthcare Passport |
$282.81
|
| Rate for Payer: Multiplan PHCS |
$1,948.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,272.90
|
| Rate for Payer: UHCCP Medicaid |
$1,136.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.64
|
|
|
CT ANGIOGRAPHY CHEST
|
Facility
|
OP
|
$3,247.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,117.12 |
| Rate for Payer: Aetna Commercial |
$2,500.19
|
| Rate for Payer: Anthem Medicaid |
$1,116.64
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.66
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cash Price |
$1,623.50
|
| Rate for Payer: Cigna Commercial |
$2,695.01
|
| Rate for Payer: First Health Commercial |
$3,084.65
|
| Rate for Payer: Humana Commercial |
$2,759.95
|
| Rate for Payer: Humana KY Medicaid |
$1,116.64
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,396.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,857.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,435.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.57
|
| Rate for Payer: PHCS Commercial |
$3,117.12
|
| Rate for Payer: United Healthcare All Payer |
$2,857.36
|
|
