|
CT ANGIOGRAPHY CHEST
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$122.45 |
| Max. Negotiated Rate |
$2,133.60 |
| Rate for Payer: Aetna Commercial |
$683.97
|
| Rate for Payer: Ambetter Exchange |
$258.88
|
| Rate for Payer: Anthem Medicaid |
$282.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.66
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cash Price |
$1,778.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$258.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$288.47
|
| Rate for Payer: Molina Healthcare Passport |
$282.81
|
| Rate for Payer: Multiplan PHCS |
$2,133.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$336.54
|
| Rate for Payer: UHCCP Medicaid |
$1,244.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.88
|
|
|
CT ANGIOGRAPHY CHEST
|
Facility
|
IP
|
$3,556.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,066.80 |
| Max. Negotiated Rate |
$3,413.76 |
| Rate for Payer: Aetna Commercial |
$2,738.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,773.68
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cigna Commercial |
$2,951.48
|
| Rate for Payer: First Health Commercial |
$3,378.20
|
| Rate for Payer: Humana Commercial |
$3,022.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,915.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,624.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,129.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,667.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,093.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,453.64
|
| Rate for Payer: PHCS Commercial |
$3,413.76
|
| Rate for Payer: United Healthcare All Payer |
$3,129.28
|
|
|
CT ANGIOGRAPHY CHEST
|
Facility
|
OP
|
$3,556.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
35000003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,413.76 |
| Rate for Payer: Aetna Commercial |
$2,738.12
|
| Rate for Payer: Anthem Medicaid |
$1,222.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,773.68
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cash Price |
$1,778.00
|
| Rate for Payer: Cigna Commercial |
$2,951.48
|
| Rate for Payer: First Health Commercial |
$3,378.20
|
| Rate for Payer: Humana Commercial |
$3,022.60
|
| Rate for Payer: Humana KY Medicaid |
$1,222.91
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,235.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,915.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,624.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,247.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,129.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,667.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,844.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,093.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,453.64
|
| Rate for Payer: PHCS Commercial |
$3,413.76
|
| Rate for Payer: United Healthcare All Payer |
$3,129.28
|
|
|
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: Ambetter Exchange |
$258.88
|
| Rate for Payer: Anthem Medicaid |
$282.81
|
| Rate for Payer: Buckeye Individual/Medicaid |
$258.88
|
| Rate for Payer: Buckeye Medicare Advantage |
$258.88
|
| Rate for Payer: CareSource Just4Me Medicare |
$310.66
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$258.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$258.88
|
| 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 |
$336.54
|
| Rate for Payer: UHCCP Medicaid |
$78.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$285.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$258.88
|
|
|
CT ANGIOGRAPHY CHEST(T
|
Facility
|
OP
|
$3,331.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
350T0003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,197.76 |
| Rate for Payer: Aetna Commercial |
$2,564.87
|
| Rate for Payer: Anthem Medicaid |
$1,145.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cigna Commercial |
$2,764.73
|
| Rate for Payer: First Health Commercial |
$3,164.45
|
| Rate for Payer: Humana Commercial |
$2,831.35
|
| Rate for Payer: Humana KY Medicaid |
$1,145.53
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,157.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,168.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.39
|
| Rate for Payer: PHCS Commercial |
$3,197.76
|
| Rate for Payer: United Healthcare All Payer |
$2,931.28
|
|
|
CT ANGIOGRAPHY CHEST(T
|
Facility
|
IP
|
$3,331.00
|
|
|
Service Code
|
HCPCS 71275
|
| Hospital Charge Code |
350T0003
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$3,197.76 |
| Rate for Payer: Aetna Commercial |
$2,564.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.18
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cigna Commercial |
$2,764.73
|
| Rate for Payer: First Health Commercial |
$3,164.45
|
| Rate for Payer: Humana Commercial |
$2,831.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.39
|
| Rate for Payer: PHCS Commercial |
$3,197.76
|
| Rate for Payer: United Healthcare All Payer |
$2,931.28
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Facility
|
IP
|
$3,591.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,077.30 |
| Max. Negotiated Rate |
$3,447.36 |
| Rate for Payer: Aetna Commercial |
$2,765.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.98
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna Commercial |
$2,980.53
|
| Rate for Payer: First Health Commercial |
$3,411.45
|
| Rate for Payer: Humana Commercial |
$3,052.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,944.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,124.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.79
|
| Rate for Payer: PHCS Commercial |
$3,447.36
|
| Rate for Payer: United Healthcare All Payer |
$3,160.08
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Facility
|
OP
|
$3,591.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,447.36 |
| Rate for Payer: Aetna Commercial |
$2,765.07
|
| Rate for Payer: Anthem Medicaid |
$1,234.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna Commercial |
$2,980.53
|
| Rate for Payer: First Health Commercial |
$3,411.45
|
| Rate for Payer: Humana Commercial |
$3,052.35
|
| Rate for Payer: Humana KY Medicaid |
$1,234.94
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,944.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,124.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.79
|
| Rate for Payer: PHCS Commercial |
$3,447.36
|
| Rate for Payer: United Healthcare All Payer |
$3,160.08
|
|
|
CT ANGIO HRT W/3D IMAGE
|
Professional
|
Both
|
$3,591.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
35000066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$146.67 |
| Max. Negotiated Rate |
$2,154.60 |
| Rate for Payer: Aetna Commercial |
$582.81
|
| Rate for Payer: Ambetter Exchange |
$297.50
|
| Rate for Payer: Anthem Medicaid |
$417.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$357.00
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$297.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.50
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$426.25
|
| Rate for Payer: Molina Healthcare Passport |
$417.89
|
| Rate for Payer: Multiplan PHCS |
$2,154.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$386.75
|
| Rate for Payer: UHCCP Medicaid |
$1,256.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.50
|
|
|
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: Ambetter Exchange |
$297.50
|
| Rate for Payer: Anthem Medicaid |
$417.89
|
| Rate for Payer: Buckeye Individual/Medicaid |
$297.50
|
| Rate for Payer: Buckeye Medicare Advantage |
$297.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$357.00
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$297.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$297.50
|
| 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 |
$386.75
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$422.07
|
| Rate for Payer: Wellcare Medicare Advantage |
$297.50
|
|
|
CT ANGIO HRT W/3D IMAGE(T
|
Facility
|
OP
|
$3,341.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
350T0066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$3,207.36 |
| Rate for Payer: Aetna Commercial |
$2,572.57
|
| Rate for Payer: Anthem Medicaid |
$1,148.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.98
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$1,670.50
|
| Rate for Payer: Cash Price |
$1,670.50
|
| Rate for Payer: Cigna Commercial |
$2,773.03
|
| Rate for Payer: First Health Commercial |
$3,173.95
|
| Rate for Payer: Humana Commercial |
$2,839.85
|
| Rate for Payer: Humana KY Medicaid |
$1,148.97
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,739.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,465.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,906.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.29
|
| Rate for Payer: PHCS Commercial |
$3,207.36
|
| Rate for Payer: United Healthcare All Payer |
$2,940.08
|
|
|
CT ANGIO HRT W/3D IMAGE(T
|
Facility
|
IP
|
$3,341.00
|
|
|
Service Code
|
HCPCS 75574
|
| Hospital Charge Code |
350T0066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,002.30 |
| Max. Negotiated Rate |
$3,207.36 |
| Rate for Payer: Aetna Commercial |
$2,572.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,605.98
|
| Rate for Payer: Cash Price |
$1,670.50
|
| Rate for Payer: Cigna Commercial |
$2,773.03
|
| Rate for Payer: First Health Commercial |
$3,173.95
|
| Rate for Payer: Humana Commercial |
$2,839.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,739.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,465.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,002.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,940.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,505.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,672.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,906.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,305.29
|
| Rate for Payer: PHCS Commercial |
$3,207.36
|
| Rate for Payer: United Healthcare All Payer |
$2,940.08
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Professional
|
Both
|
$3,611.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
35000058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$121.59 |
| Max. Negotiated Rate |
$2,166.60 |
| Rate for Payer: Aetna Commercial |
$682.46
|
| Rate for Payer: Ambetter Exchange |
$295.69
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$295.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$354.83
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cash Price |
$1,805.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.69
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$251.34
|
| Rate for Payer: Molina Healthcare Passport |
$246.41
|
| Rate for Payer: Multiplan PHCS |
$2,166.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$384.40
|
| Rate for Payer: UHCCP Medicaid |
$1,263.85
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$295.69
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Facility
|
IP
|
$3,611.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
35000058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,083.30 |
| Max. Negotiated Rate |
$3,466.56 |
| Rate for Payer: Aetna Commercial |
$2,780.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.58
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cigna Commercial |
$2,997.13
|
| Rate for Payer: First Health Commercial |
$3,430.45
|
| Rate for Payer: Humana Commercial |
$3,069.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,177.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,708.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,888.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,141.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.59
|
| Rate for Payer: PHCS Commercial |
$3,466.56
|
| Rate for Payer: United Healthcare All Payer |
$3,177.68
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE
|
Facility
|
OP
|
$3,611.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
35000058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,466.56 |
| Rate for Payer: Aetna Commercial |
$2,780.47
|
| Rate for Payer: Anthem Medicaid |
$1,241.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.58
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cash Price |
$1,805.50
|
| Rate for Payer: Cigna Commercial |
$2,997.13
|
| Rate for Payer: First Health Commercial |
$3,430.45
|
| Rate for Payer: Humana Commercial |
$3,069.35
|
| Rate for Payer: Humana KY Medicaid |
$1,241.82
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,961.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,266.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,177.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,708.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,888.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,141.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,491.59
|
| Rate for Payer: PHCS Commercial |
$3,466.56
|
| Rate for Payer: United Healthcare All Payer |
$3,177.68
|
|
|
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: Ambetter Exchange |
$295.69
|
| Rate for Payer: Anthem Medicaid |
$246.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$295.69
|
| Rate for Payer: Buckeye Medicare Advantage |
$295.69
|
| Rate for Payer: CareSource Just4Me Medicare |
$354.83
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$295.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$295.69
|
| 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 |
$384.40
|
| Rate for Payer: UHCCP Medicaid |
$98.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$248.87
|
| Rate for Payer: Wellcare Medicare Advantage |
$295.69
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE(T
|
Facility
|
IP
|
$3,331.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
350T0058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$3,197.76 |
| Rate for Payer: Aetna Commercial |
$2,564.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.18
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cigna Commercial |
$2,764.73
|
| Rate for Payer: First Health Commercial |
$3,164.45
|
| Rate for Payer: Humana Commercial |
$2,831.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.39
|
| Rate for Payer: PHCS Commercial |
$3,197.76
|
| Rate for Payer: United Healthcare All Payer |
$2,931.28
|
|
|
CT ANGIO LWR EXTR W/O&W/DYE(T
|
Facility
|
OP
|
$3,331.00
|
|
|
Service Code
|
HCPCS 73706
|
| Hospital Charge Code |
350T0058
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$3,197.76 |
| Rate for Payer: Aetna Commercial |
$2,564.87
|
| Rate for Payer: Anthem Medicaid |
$1,145.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$164.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,598.18
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$230.29
|
| Rate for Payer: CareSource Just4Me Medicare |
$222.06
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cash Price |
$1,665.50
|
| Rate for Payer: Cigna Commercial |
$2,764.73
|
| Rate for Payer: First Health Commercial |
$3,164.45
|
| Rate for Payer: Humana Commercial |
$2,831.35
|
| Rate for Payer: Humana KY Medicaid |
$1,145.53
|
| Rate for Payer: Humana Medicare Advantage |
$164.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,157.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,731.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,458.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$197.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,168.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,931.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,498.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,664.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,897.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,298.39
|
| Rate for Payer: PHCS Commercial |
$3,197.76
|
| Rate for Payer: United Healthcare All Payer |
$2,931.28
|
|
|
C-TAPER HEAD 26MM +0
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.70 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem Medicaid |
$1,495.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Humana KY Medicaid |
$1,495.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,510.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,525.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,783.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,000.81
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
C-TAPER HEAD 26MM +0
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.70 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,783.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,000.81
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
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 |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
C-TAPER HEAD 26MM +10
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| 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 |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
C-TAPER HEAD 26MM +5
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.70 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem Medicaid |
$1,495.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Humana KY Medicaid |
$1,495.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,510.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,525.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,783.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,000.81
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
C-TAPER HEAD 26MM +5
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,304.70 |
| Max. Negotiated Rate |
$4,175.04 |
| Rate for Payer: Aetna Commercial |
$3,348.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,392.22
|
| Rate for Payer: Cash Price |
$2,174.50
|
| Rate for Payer: Cigna Commercial |
$3,609.67
|
| Rate for Payer: First Health Commercial |
$4,131.55
|
| Rate for Payer: Humana Commercial |
$3,696.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,566.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,209.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,304.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,827.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,261.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,479.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,783.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,000.81
|
| Rate for Payer: PHCS Commercial |
$4,175.04
|
| Rate for Payer: United Healthcare All Payer |
$3,827.12
|
|
|
C-TAPER HEAD 28MM +2.5
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
