|
CT ANGIOGRAPHY CHEST(P
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
350P0003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$820.27 |
| Rate for Payer: Aetna Commercial |
$683.97
|
| Rate for Payer: Anthem Medicaid |
$282.81
|
| 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 |
$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 |
$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 |
$285.64
|
|
|
CT ANGIOGRAPHY CHEST(T
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
350T0003
|
|
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 ANGIOGRAPHY CHEST(T
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
350T0003
|
|
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 HRT W/3D IMAGE
|
Facility
|
IP
|
$3,387.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$440.31 |
| Max. Negotiated Rate |
$3,251.52 |
| Rate for Payer: Aetna Commercial |
$2,607.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,641.86
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$2,811.21
|
| Rate for Payer: First Health Commercial |
$3,217.65
|
| Rate for Payer: Humana Commercial |
$2,878.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,777.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,499.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,980.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,540.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.97
|
| Rate for Payer: PHCS Commercial |
$3,251.52
|
| Rate for Payer: United Healthcare All Payer |
$2,980.56
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Facility
|
OP
|
$3,387.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,251.52 |
| Rate for Payer: Aetna Commercial |
$2,607.99
|
| Rate for Payer: Anthem Medicaid |
$1,164.79
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,641.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$2,811.21
|
| Rate for Payer: First Health Commercial |
$3,217.65
|
| Rate for Payer: Humana Commercial |
$2,878.95
|
| Rate for Payer: Humana KY Medicaid |
$1,164.79
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,176.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,777.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,499.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,188.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,980.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,540.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.97
|
| Rate for Payer: PHCS Commercial |
$3,251.52
|
| Rate for Payer: United Healthcare All Payer |
$2,980.56
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Professional
|
Both
|
$3,387.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$3,387.00 |
| Rate for Payer: Aetna Commercial |
$582.81
|
| Rate for Payer: Anthem Medicaid |
$417.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,387.00
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$896.72
|
| Rate for Payer: Healthspan PPO |
$373.16
|
| Rate for Payer: Humana Medicaid |
$417.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$426.25
|
| Rate for Payer: Molina Healthcare Passport |
$417.89
|
| Rate for Payer: Multiplan PHCS |
$2,032.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,370.90
|
| Rate for Payer: UHCCP Medicaid |
$1,185.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.07
|
|
|
CT ANGIO HRT W/3D IMAGE(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
350P0066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$896.72 |
| Rate for Payer: Aetna Commercial |
$582.81
|
| Rate for Payer: Anthem Medicaid |
$417.89
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$896.72
|
| Rate for Payer: Healthspan PPO |
$373.16
|
| Rate for Payer: Humana Medicaid |
$417.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$146.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$426.25
|
| Rate for Payer: Molina Healthcare Passport |
$417.89
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.07
|
|
|
CT ANGIO HRT W/3D IMAGE(T
|
Facility
|
OP
|
$3,137.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
350T0066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,011.52 |
| Rate for Payer: Aetna Commercial |
$2,415.49
|
| Rate for Payer: Anthem Medicaid |
$1,078.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,446.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,568.50
|
| Rate for Payer: Cash Price |
$1,568.50
|
| Rate for Payer: Cigna Commercial |
$2,603.71
|
| Rate for Payer: First Health Commercial |
$2,980.15
|
| Rate for Payer: Humana Commercial |
$2,666.45
|
| Rate for Payer: Humana KY Medicaid |
$1,078.81
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,089.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,572.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,315.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,100.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,760.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,352.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.47
|
| Rate for Payer: PHCS Commercial |
$3,011.52
|
| Rate for Payer: United Healthcare All Payer |
$2,760.56
|
|
|
CT ANGIO HRT W/3D IMAGE(T
|
Facility
|
IP
|
$3,137.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
350T0066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$407.81 |
| Max. Negotiated Rate |
$3,011.52 |
| Rate for Payer: Aetna Commercial |
$2,415.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,446.86
|
| Rate for Payer: Cash Price |
$1,568.50
|
| Rate for Payer: Cigna Commercial |
$2,603.71
|
| Rate for Payer: First Health Commercial |
$2,980.15
|
| Rate for Payer: Humana Commercial |
$2,666.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,572.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,315.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$941.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,760.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,352.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.47
|
| Rate for Payer: PHCS Commercial |
$3,011.52
|
| Rate for Payer: United Healthcare All Payer |
$2,760.56
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$3,408.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
35000058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$443.04 |
| Max. Negotiated Rate |
$3,271.68 |
| Rate for Payer: Aetna Commercial |
$2,624.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,658.24
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$2,828.64
|
| Rate for Payer: First Health Commercial |
$3,237.60
|
| Rate for Payer: Humana Commercial |
$2,896.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,515.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,999.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,556.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.48
|
| Rate for Payer: PHCS Commercial |
$3,271.68
|
| Rate for Payer: United Healthcare All Payer |
$2,999.04
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$3,408.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
35000058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$158.88 |
| Max. Negotiated Rate |
$3,271.68 |
| Rate for Payer: Aetna Commercial |
$2,624.16
|
| Rate for Payer: Anthem Medicaid |
$1,172.01
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$158.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,658.24
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$222.43
|
| Rate for Payer: CareSource Just4Me Medicare |
$214.49
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$2,828.64
|
| Rate for Payer: First Health Commercial |
$3,237.60
|
| Rate for Payer: Humana Commercial |
$2,896.80
|
| Rate for Payer: Humana KY Medicaid |
$1,172.01
|
| Rate for Payer: Humana Medicare Advantage |
$158.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,515.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$190.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,999.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,556.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.48
|
| Rate for Payer: PHCS Commercial |
$3,271.68
|
| Rate for Payer: United Healthcare All Payer |
$2,999.04
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Professional
|
Both
|
$3,408.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
35000058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$121.59 |
| Max. Negotiated Rate |
$3,408.00 |
| Rate for Payer: Healthspan PPO |
$468.95
|
| Rate for Payer: Aetna Commercial |
$682.46
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,408.00
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$767.80
|
| Rate for Payer: Humana Medicaid |
$246.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$2,044.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,385.60
|
| Rate for Payer: UHCCP Medicaid |
$1,192.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE(P
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
350P0058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$767.80 |
| Rate for Payer: Aetna Commercial |
$682.46
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$280.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cigna Commercial |
$767.80
|
| Rate for Payer: Healthspan PPO |
$468.95
|
| Rate for Payer: Humana Medicaid |
$246.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$121.59
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$168.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$196.00
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE(T
|
Facility
|
OP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
350T0058
|
|
Hospital Revenue Code
|
352
|
| 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 LWR EXTR W/O&W/DYE(T
|
Facility
|
IP
|
$3,128.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
350T0058
|
|
Hospital Revenue Code
|
352
|
| 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
|
|
|
C-TAPER HEAD 26MM +0
|
Facility
|
OP
|
$4,392.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.01 |
| Max. Negotiated Rate |
$4,216.70 |
| Rate for Payer: Aetna Commercial |
$3,382.15
|
| Rate for Payer: Anthem Medicaid |
$1,510.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,426.07
|
| Rate for Payer: Cash Price |
$2,196.20
|
| Rate for Payer: Cigna Commercial |
$3,645.69
|
| Rate for Payer: First Health Commercial |
$4,172.78
|
| Rate for Payer: Humana Commercial |
$3,733.54
|
| Rate for Payer: Humana KY Medicaid |
$1,510.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,601.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,241.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,540.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,865.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,294.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.64
|
| Rate for Payer: PHCS Commercial |
$4,216.70
|
| Rate for Payer: United Healthcare All Payer |
$3,865.31
|
|
|
C-TAPER HEAD 26MM +0
|
Facility
|
IP
|
$4,392.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.01 |
| Max. Negotiated Rate |
$4,216.70 |
| Rate for Payer: Aetna Commercial |
$3,382.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,426.07
|
| Rate for Payer: Cash Price |
$2,196.20
|
| Rate for Payer: Cigna Commercial |
$3,645.69
|
| Rate for Payer: First Health Commercial |
$4,172.78
|
| Rate for Payer: Humana Commercial |
$3,733.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,601.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,241.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,865.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,294.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.64
|
| Rate for Payer: PHCS Commercial |
$4,216.70
|
| Rate for Payer: United Healthcare All Payer |
$3,865.31
|
|
|
C-TAPER HEAD 26MM +10
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
C-TAPER HEAD 26MM +10
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
C-TAPER HEAD 26MM +5
|
Facility
|
IP
|
$4,392.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.01 |
| Max. Negotiated Rate |
$4,216.70 |
| Rate for Payer: Aetna Commercial |
$3,382.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,426.07
|
| Rate for Payer: Cash Price |
$2,196.20
|
| Rate for Payer: Cigna Commercial |
$3,645.69
|
| Rate for Payer: First Health Commercial |
$4,172.78
|
| Rate for Payer: Humana Commercial |
$3,733.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,601.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,241.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,865.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,294.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.64
|
| Rate for Payer: PHCS Commercial |
$4,216.70
|
| Rate for Payer: United Healthcare All Payer |
$3,865.31
|
|
|
C-TAPER HEAD 26MM +5
|
Facility
|
OP
|
$4,392.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.01 |
| Max. Negotiated Rate |
$4,216.70 |
| Rate for Payer: Aetna Commercial |
$3,382.15
|
| Rate for Payer: Anthem Medicaid |
$1,510.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,426.07
|
| Rate for Payer: Cash Price |
$2,196.20
|
| Rate for Payer: Cigna Commercial |
$3,645.69
|
| Rate for Payer: First Health Commercial |
$4,172.78
|
| Rate for Payer: Humana Commercial |
$3,733.54
|
| Rate for Payer: Humana KY Medicaid |
$1,510.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,601.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,241.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,540.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,865.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,294.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,361.64
|
| Rate for Payer: PHCS Commercial |
$4,216.70
|
| Rate for Payer: United Healthcare All Payer |
$3,865.31
|
|
|
C-TAPER HEAD 28MM +2.5
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD 28MM +2.5
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD 28MM +7.5
|
Facility
|
IP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
|
C-TAPER HEAD 28MM +7.5
|
Facility
|
OP
|
$5,455.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$709.15 |
| Max. Negotiated Rate |
$5,236.80 |
| Rate for Payer: Aetna Commercial |
$4,200.35
|
| Rate for Payer: Anthem Medicaid |
$1,875.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,254.90
|
| Rate for Payer: Cash Price |
$2,727.50
|
| Rate for Payer: Cigna Commercial |
$4,527.65
|
| Rate for Payer: First Health Commercial |
$5,182.25
|
| Rate for Payer: Humana Commercial |
$4,636.75
|
| Rate for Payer: Humana KY Medicaid |
$1,875.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,895.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,473.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,025.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,636.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,913.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,800.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,091.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,091.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$709.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,691.05
|
| Rate for Payer: PHCS Commercial |
$5,236.80
|
| Rate for Payer: United Healthcare All Payer |
$4,800.40
|
|
