|
GUIDANCE FOR RADJ TX DLVR
|
Professional
|
Both
|
$1,569.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
33300023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$99.29 |
| Max. Negotiated Rate |
$1,098.30 |
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cash Price |
$784.50
|
| Rate for Payer: Cigna Commercial |
$99.29
|
| Rate for Payer: Multiplan PHCS |
$941.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,098.30
|
| Rate for Payer: UHCCP Medicaid |
$549.15
|
|
|
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: 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
|
IP
|
$1,519.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
333T0023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$1,458.24 |
| Rate for Payer: Aetna Commercial |
$1,169.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.82
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna Commercial |
$1,260.77
|
| Rate for Payer: First Health Commercial |
$1,443.05
|
| Rate for Payer: Humana Commercial |
$1,291.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.11
|
| Rate for Payer: PHCS Commercial |
$1,458.24
|
| Rate for Payer: United Healthcare All Payer |
$1,336.72
|
|
|
GUIDANCE FOR RADJ TX DLVR(T
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
HCPCS 77387
|
| Hospital Charge Code |
333T0023
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$1,458.24 |
| Rate for Payer: Aetna Commercial |
$1,169.63
|
| Rate for Payer: Anthem Medicaid |
$522.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,184.82
|
| Rate for Payer: Cash Price |
$759.50
|
| Rate for Payer: Cigna Commercial |
$1,260.77
|
| Rate for Payer: First Health Commercial |
$1,443.05
|
| Rate for Payer: Humana Commercial |
$1,291.15
|
| Rate for Payer: Humana KY Medicaid |
$522.38
|
| Rate for Payer: Kentucky WC Medicaid |
$527.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,245.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$455.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$532.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,336.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,139.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,215.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,321.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.11
|
| Rate for Payer: PHCS Commercial |
$1,458.24
|
| Rate for Payer: United Healthcare All Payer |
$1,336.72
|
|
|
GUIDE CATH 3DR 5F
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
GUIDE CATH 3DR 5F
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
GUIDE CATH 3DRC 6F
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
GUIDE CATH 3DRC 6F
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
GUIDE CATH 6216A-MB2
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
GUIDE CATH 6216A-MB2
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem Medicaid |
$603.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Humana KY Medicaid |
$603.89
|
| Rate for Payer: Kentucky WC Medicaid |
$610.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
GUIDE CATH 6216A-MP
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
GUIDE CATH 6216A-MP
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$1,685.76 |
| Rate for Payer: Aetna Commercial |
$1,352.12
|
| Rate for Payer: Anthem Medicaid |
$603.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,369.68
|
| Rate for Payer: Cash Price |
$878.00
|
| Rate for Payer: Cigna Commercial |
$1,457.48
|
| Rate for Payer: First Health Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial |
$1,492.60
|
| Rate for Payer: Humana KY Medicaid |
$603.89
|
| Rate for Payer: Kentucky WC Medicaid |
$610.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,439.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,295.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$526.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$616.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,545.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,317.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,404.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,527.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.64
|
| Rate for Payer: PHCS Commercial |
$1,685.76
|
| Rate for Payer: United Healthcare All Payer |
$1,545.28
|
|
|
GUIDE CATH AL 2.0 8FR
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDE CATH AL 2.0 8FR
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDE CATH AL .75 8FR
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDE CATH AL .75 8FR
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
GUIDE CATHET FLUID DRAINAGE
|
Facility
|
OP
|
$2,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$650.10 |
| 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 |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,279.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| 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 |
$650.10
|
| 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 |
$780.12
|
| 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 |
$2,337.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,542.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.18
|
| Rate for Payer: PHCS Commercial |
$2,805.12
|
| Rate for Payer: United Healthcare All Payer |
$2,571.36
|
|
|
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 |
$1,753.20 |
| Rate for Payer: Ambetter Exchange |
$126.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.43
|
| Rate for Payer: Anthem Medicaid |
$581.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$151.97
|
| 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 |
$581.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$593.24
|
| Rate for Payer: Molina Healthcare Passport |
$581.61
|
| Rate for Payer: Multiplan PHCS |
$1,753.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.63
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.64
|
|
|
GUIDE CATHET FLUID DRAINAGE
|
Facility
|
IP
|
$2,922.00
|
|
|
Service Code
|
HCPCS 10030
|
| Hospital Charge Code |
76100005
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$876.60 |
| 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 |
$2,337.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,542.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.18
|
| 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 |
$947.05 |
| Rate for Payer: Ambetter Exchange |
$126.64
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$119.43
|
| Rate for Payer: Anthem Medicaid |
$581.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$126.64
|
| Rate for Payer: Buckeye Medicare Advantage |
$126.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$151.97
|
| 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 |
$581.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$196.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$126.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$126.64
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$593.24
|
| Rate for Payer: Molina Healthcare Passport |
$581.61
|
| Rate for Payer: Multiplan PHCS |
$600.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.63
|
| Rate for Payer: UHCCP Medicaid |
$125.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$587.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$126.64
|
|
|
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 |
$650.10 |
| 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 |
$650.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,499.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$910.14
|
| Rate for Payer: CareSource Just4Me Medicare |
$877.63
|
| 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 |
$650.10
|
| 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 |
$780.12
|
| 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 |
$1,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,672.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,326.18
|
| Rate for Payer: PHCS Commercial |
$1,845.12
|
| Rate for Payer: United Healthcare All Payer |
$1,691.36
|
|
|
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 |
$576.60 |
| 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 |
$1,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,672.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,326.18
|
| Rate for Payer: PHCS Commercial |
$1,845.12
|
| Rate for Payer: United Healthcare All Payer |
$1,691.36
|
|
|
GUIDE CATH. IM 5F
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem Medicaid |
$273.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Humana KY Medicaid |
$273.40
|
| Rate for Payer: Kentucky WC Medicaid |
$276.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$278.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
GUIDE CATH. IM 5F
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: Aetna Commercial |
$612.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$620.10
|
| Rate for Payer: Cash Price |
$397.50
|
| Rate for Payer: Cigna Commercial |
$659.85
|
| Rate for Payer: First Health Commercial |
$755.25
|
| Rate for Payer: Humana Commercial |
$675.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$651.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$586.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$238.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$699.60
|
| Rate for Payer: Ohio Health Group HMO |
$596.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.55
|
| Rate for Payer: PHCS Commercial |
$763.20
|
| Rate for Payer: United Healthcare All Payer |
$699.60
|
|
|
GUIDE CATH JR 3.5 8FR
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
