|
GUIDANCE FOR RADJ TX DLVR
|
Facility
|
IP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
GUIDANCE FOR RADJ TX DLVR
|
Facility
|
OP
|
$1,518.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$197.34 |
| Max. Negotiated Rate |
$1,457.28 |
| Rate for Payer: Aetna Commercial |
$1,168.86
|
| Rate for Payer: Anthem Medicaid |
$522.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.04
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$1,259.94
|
| Rate for Payer: First Health Commercial |
$1,442.10
|
| Rate for Payer: Humana Commercial |
$1,290.30
|
| Rate for Payer: Humana KY Medicaid |
$522.04
|
| Rate for Payer: Kentucky WC Medicaid |
$527.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,244.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,120.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,335.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,138.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$470.58
|
| Rate for Payer: PHCS Commercial |
$1,457.28
|
| Rate for Payer: United Healthcare All Payer |
$1,335.84
|
|
|
GUIDANCE FOR RADJ TX DLVR
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$1,518.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$1,518.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cash Price |
$759.00
|
| Rate for Payer: Cigna Commercial |
$99.29
|
| Rate for Payer: Multiplan PHCS |
$910.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,062.60
|
| Rate for Payer: UHCCP Medicaid |
$531.30
|
|
|
GUIDANCE FOR RADJ TX DLVR(P
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
333P0023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$99.29 |
| Rate for Payer: Buckeye Medicare Advantage |
$50.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cash Price |
$25.00
|
| Rate for Payer: Cigna Commercial |
$99.29
|
| Rate for Payer: Multiplan PHCS |
$30.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$35.00
|
| Rate for Payer: UHCCP Medicaid |
$17.50
|
|
|
GUIDANCE FOR RADJ TX DLVR(T
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
333T0023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$1,409.28 |
| Rate for Payer: Aetna Commercial |
$1,130.36
|
| Rate for Payer: Anthem Medicaid |
$504.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.04
|
| Rate for Payer: Cash Price |
$734.00
|
| Rate for Payer: Cigna Commercial |
$1,218.44
|
| Rate for Payer: First Health Commercial |
$1,394.60
|
| Rate for Payer: Humana Commercial |
$1,247.80
|
| Rate for Payer: Humana KY Medicaid |
$504.85
|
| Rate for Payer: Kentucky WC Medicaid |
$509.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,203.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,083.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$514.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,291.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,101.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.08
|
| Rate for Payer: PHCS Commercial |
$1,409.28
|
| Rate for Payer: United Healthcare All Payer |
$1,291.84
|
|
|
GUIDANCE FOR RADJ TX DLVR(T
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
333T0023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$190.84 |
| Max. Negotiated Rate |
$1,409.28 |
| Rate for Payer: Aetna Commercial |
$1,130.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,145.04
|
| Rate for Payer: Cash Price |
$734.00
|
| Rate for Payer: Cigna Commercial |
$1,218.44
|
| Rate for Payer: First Health Commercial |
$1,394.60
|
| Rate for Payer: Humana Commercial |
$1,247.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,203.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,083.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$440.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,291.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,101.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$293.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$190.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$455.08
|
| Rate for Payer: PHCS Commercial |
$1,409.28
|
| Rate for Payer: United Healthcare All Payer |
$1,291.84
|
|
|
GUIDE CATH 3DR 5F
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
GUIDE CATH 3DR 5F
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
GUIDE CATH 3DRC 6F
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
GUIDE CATH 3DRC 6F
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
GUIDE CATH 6216A-MB2
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
GUIDE CATH 6216A-MB2
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
GUIDE CATH 6216A-MP
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem Medicaid |
$608.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Humana KY Medicaid |
$608.70
|
| Rate for Payer: Kentucky WC Medicaid |
$614.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
GUIDE CATH 6216A-MP
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.10 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Aetna Commercial |
$1,362.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,380.60
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$1,469.10
|
| Rate for Payer: First Health Commercial |
$1,681.50
|
| Rate for Payer: Humana Commercial |
$1,504.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,451.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,306.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,557.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,327.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.70
|
| Rate for Payer: PHCS Commercial |
$1,699.20
|
| Rate for Payer: United Healthcare All Payer |
$1,557.60
|
|
|
GUIDE CATH AL 2.0 8FR
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CATH AL 2.0 8FR
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CATH AL .75 8FR
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CATH AL .75 8FR
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
GUIDE CATHET FLUID DRAINAGE
|
Professional
|
Both
|
$2,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$2,922.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.43
|
| Rate for Payer: Anthem Medicaid |
$125.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,922.00
|
| Rate for Payer: Cash Price |
$1,461.00
|
| Rate for Payer: Cash Price |
$1,461.00
|
| Rate for Payer: Cigna Commercial |
$256.79
|
| Rate for Payer: Healthspan PPO |
$947.05
|
| Rate for Payer: Humana Medicaid |
$125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.25
|
| Rate for Payer: Molina Healthcare Passport |
$125.74
|
| Rate for Payer: Multiplan PHCS |
$1,753.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,045.40
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.00
|
|
|
GUIDE CATHET FLUID DRAINAGE
|
Facility
|
IP
|
$2,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$2,805.12 |
| Rate for Payer: Aetna Commercial |
$2,249.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,279.16
|
| Rate for Payer: Cash Price |
$1,461.00
|
| Rate for Payer: Cigna Commercial |
$2,425.26
|
| Rate for Payer: First Health Commercial |
$2,775.90
|
| Rate for Payer: Humana Commercial |
$2,483.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,396.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,156.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$876.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,571.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,191.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$584.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$379.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.82
|
| Rate for Payer: PHCS Commercial |
$2,805.12
|
| Rate for Payer: United Healthcare All Payer |
$2,571.36
|
|
|
GUIDE CATHET FLUID DRAINAGE
|
Facility
|
OP
|
$2,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$379.86 |
| Max. Negotiated Rate |
$2,805.12 |
| Rate for Payer: Aetna Commercial |
$2,249.94
|
| Rate for Payer: Anthem Medicaid |
$1,004.88
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,279.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$1,461.00
|
| Rate for Payer: Cash Price |
$1,461.00
|
| Rate for Payer: Cigna Commercial |
$2,425.26
|
| Rate for Payer: First Health Commercial |
$2,775.90
|
| Rate for Payer: Humana Commercial |
$2,483.70
|
| Rate for Payer: Humana KY Medicaid |
$1,004.88
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,015.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,396.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,156.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,025.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,571.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,191.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$584.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$379.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$905.82
|
| Rate for Payer: PHCS Commercial |
$2,805.12
|
| Rate for Payer: United Healthcare All Payer |
$2,571.36
|
|
|
GUIDE CATHET FLUID DRAINAGE(P
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
761P0005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.43
|
| Rate for Payer: Anthem Medicaid |
$125.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,000.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$256.79
|
| Rate for Payer: Healthspan PPO |
$947.05
|
| Rate for Payer: Humana Medicaid |
$125.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.29
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$128.25
|
| Rate for Payer: Molina Healthcare Passport |
$125.74
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$700.00
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$127.00
|
|
|
GUIDE CATHET FLUID DRAINAGE(T
|
Facility
|
IP
|
$1,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
761T0005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.86 |
| Max. Negotiated Rate |
$1,845.12 |
| Rate for Payer: Aetna Commercial |
$1,479.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,499.16
|
| Rate for Payer: Cash Price |
$961.00
|
| Rate for Payer: Cigna Commercial |
$1,595.26
|
| Rate for Payer: First Health Commercial |
$1,825.90
|
| Rate for Payer: Humana Commercial |
$1,633.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,576.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,418.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,691.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,441.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.82
|
| Rate for Payer: PHCS Commercial |
$1,845.12
|
| Rate for Payer: United Healthcare All Payer |
$1,691.36
|
|
|
GUIDE CATHET FLUID DRAINAGE(T
|
Facility
|
OP
|
$1,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
761T0005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$249.86 |
| Max. Negotiated Rate |
$1,845.12 |
| Rate for Payer: Aetna Commercial |
$1,479.94
|
| Rate for Payer: Anthem Medicaid |
$660.98
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$608.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,499.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$851.79
|
| Rate for Payer: CareSource Just4Me Medicare |
$821.37
|
| Rate for Payer: Cash Price |
$961.00
|
| Rate for Payer: Cash Price |
$961.00
|
| Rate for Payer: Cigna Commercial |
$1,595.26
|
| Rate for Payer: First Health Commercial |
$1,825.90
|
| Rate for Payer: Humana Commercial |
$1,633.70
|
| Rate for Payer: Humana KY Medicaid |
$660.98
|
| Rate for Payer: Humana Medicare Advantage |
$608.42
|
| Rate for Payer: Kentucky WC Medicaid |
$667.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,576.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,418.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$730.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,691.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,441.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.82
|
| Rate for Payer: PHCS Commercial |
$1,845.12
|
| Rate for Payer: United Healthcare All Payer |
$1,691.36
|
|
|
GUIDE CATH. IM 5F
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
