|
52MM GLNOD W/56MM SUFC KEEL
|
Facility
OP
|
$8,607.15
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$6,627.51
|
| Rate for Payer: Anthem Medicaid |
$2,960.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,713.58
|
| Rate for Payer: Cash Price |
$4,303.58
|
| Rate for Payer: Cigna Commercial |
$7,143.93
|
| Rate for Payer: First Health Commercial |
$8,176.79
|
| Rate for Payer: Humana Commercial |
$7,316.08
|
| Rate for Payer: Humana KY Medicaid |
$2,960.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,057.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,352.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,574.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,455.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,118.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.22
|
| Rate for Payer: PHCS Commercial |
$8,262.86
|
| Rate for Payer: United Healthcare All Payer |
$7,574.29
|
|
|
5 FR DUAL BIOFLO W/LONG WIRE
|
Facility
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
|
|
5 FR DUAL BIOFLO W/LONG WIRE
|
Facility
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
5 FRENCH PIGTAIL 100CM
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
5 FRENCH PIGTAIL 100CM
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
|
|
5FR IM CATH 100CM
|
Facility
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
|
|
5FR IM CATH 100CM
|
Facility
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$12,611.28 |
| Rate for Payer: Aetna Commercial |
$126.33
|
| Rate for Payer: Anthem Medicaid |
$56.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.97
|
| Rate for Payer: Cash Price |
$82.03
|
| Rate for Payer: Cigna Commercial |
$136.18
|
| Rate for Payer: First Health Commercial |
$155.87
|
| Rate for Payer: Humana Commercial |
$139.46
|
| Rate for Payer: Humana KY Medicaid |
$56.42
|
| Rate for Payer: Kentucky WC Medicaid |
$57.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.38
|
| Rate for Payer: Ohio Health Group HMO |
$123.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.86
|
| Rate for Payer: PHCS Commercial |
$157.51
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
650 36MM RETENTVE POLY LNR+0MM
|
Facility
OP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem Medicaid |
$2,366.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Humana KY Medicaid |
$2,366.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
| Rate for Payer: United Healthcare All Payer |
$6,055.50
|
|
|
650 36MM RETENTVE POLY LNR+0MM
|
Facility
IP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
|
|
650 36MM RETENTVE POLY LNR+3MM
|
Facility
OP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem Medicaid |
$2,366.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Humana KY Medicaid |
$2,366.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
| Rate for Payer: United Healthcare All Payer |
$6,055.50
|
|
|
650 36MM RETENTVE POLY LNR+3MM
|
Facility
IP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
|
|
650 36MM RETENTVE POLY LNR+6MM
|
Facility
IP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
|
|
650 36MM RETENTVE POLY LNR+6MM
|
Facility
OP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem Medicaid |
$2,366.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Humana KY Medicaid |
$2,366.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
| Rate for Payer: United Healthcare All Payer |
$6,055.50
|
|
|
650 40MM RETENTVE POLY LNR+0MM
|
Facility
OP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem Medicaid |
$2,366.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Humana KY Medicaid |
$2,366.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
| Rate for Payer: United Healthcare All Payer |
$6,055.50
|
|
|
650 40MM RETENTVE POLY LNR+0MM
|
Facility
IP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
|
|
650 40MM RETENTVE POLY LNR+3MM
|
Facility
IP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
|
|
650 40MM RETENTVE POLY LNR+3MM
|
Facility
OP
|
$6,881.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$195,234.43 |
| Rate for Payer: Aetna Commercial |
$5,298.56
|
| Rate for Payer: Anthem Medicaid |
$2,366.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,367.38
|
| Rate for Payer: Cash Price |
$3,440.62
|
| Rate for Payer: Cigna Commercial |
$5,711.44
|
| Rate for Payer: First Health Commercial |
$6,537.19
|
| Rate for Payer: Humana Commercial |
$5,849.06
|
| Rate for Payer: Humana KY Medicaid |
$2,366.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,390.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,642.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,078.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,055.50
|
| Rate for Payer: Ohio Health Group HMO |
$5,160.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.19
|
| Rate for Payer: PHCS Commercial |
$6,606.00
|
| Rate for Payer: United Healthcare All Payer |
$6,055.50
|
|
|
6 FR ANGIO SEAL VIP 610130
|
Facility
OP
|
$2,207.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$10,631.52 |
| Rate for Payer: Aetna Commercial |
$1,699.78
|
| Rate for Payer: Anthem Medicaid |
$759.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.85
|
| Rate for Payer: Cash Price |
$1,103.75
|
| Rate for Payer: Cigna Commercial |
$1,832.22
|
| Rate for Payer: First Health Commercial |
$2,097.12
|
| Rate for Payer: Humana Commercial |
$1,876.38
|
| Rate for Payer: Humana KY Medicaid |
$759.16
|
| Rate for Payer: Kentucky WC Medicaid |
$766.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$441.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.32
|
| Rate for Payer: PHCS Commercial |
$2,119.20
|
| Rate for Payer: United Healthcare All Payer |
$1,942.60
|
|
|
6 FR ANGIO SEAL VIP 610130
|
Facility
IP
|
$2,207.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$10,631.52 |
| Rate for Payer: Aetna Commercial |
$1,699.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.85
|
| Rate for Payer: Cash Price |
$1,103.75
|
| Rate for Payer: Cigna Commercial |
$1,832.22
|
| Rate for Payer: First Health Commercial |
$2,097.12
|
| Rate for Payer: Humana Commercial |
$1,876.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$441.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.32
|
| Rate for Payer: PHCS Commercial |
$2,119.20
|
|
|
6FR AR MOD 100CM
|
Facility
IP
|
$166.02
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.50
|
| Rate for Payer: Cash Price |
$83.01
|
| Rate for Payer: Cigna Commercial |
$137.80
|
| Rate for Payer: First Health Commercial |
$157.72
|
| Rate for Payer: Humana Commercial |
$141.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.10
|
| Rate for Payer: Ohio Health Group HMO |
$124.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.47
|
| Rate for Payer: PHCS Commercial |
$159.38
|
|
|
6FR AR MOD 100CM
|
Facility
OP
|
$166.02
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Anthem Medicaid |
$57.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.50
|
| Rate for Payer: Cash Price |
$83.01
|
| Rate for Payer: Cigna Commercial |
$137.80
|
| Rate for Payer: First Health Commercial |
$157.72
|
| Rate for Payer: Humana Commercial |
$141.12
|
| Rate for Payer: Humana KY Medicaid |
$57.09
|
| Rate for Payer: Kentucky WC Medicaid |
$57.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.10
|
| Rate for Payer: Ohio Health Group HMO |
$124.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.47
|
| Rate for Payer: PHCS Commercial |
$159.38
|
| Rate for Payer: United Healthcare All Payer |
$146.10
|
|
|
7 FR SHEATH
|
Facility
OP
|
$491.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$378.65
|
| Rate for Payer: Anthem Medicaid |
$169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.56
|
| Rate for Payer: Cash Price |
$245.88
|
| Rate for Payer: Cigna Commercial |
$408.15
|
| Rate for Payer: First Health Commercial |
$467.16
|
| Rate for Payer: Humana Commercial |
$417.99
|
| Rate for Payer: Humana KY Medicaid |
$169.11
|
| Rate for Payer: Kentucky WC Medicaid |
$170.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.74
|
| Rate for Payer: Ohio Health Group HMO |
$368.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.44
|
| Rate for Payer: PHCS Commercial |
$472.08
|
| Rate for Payer: United Healthcare All Payer |
$432.74
|
|
|
7 FR SHEATH
|
Facility
IP
|
$491.75
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$10,176.00 |
| Rate for Payer: Aetna Commercial |
$378.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$383.56
|
| Rate for Payer: Cash Price |
$245.88
|
| Rate for Payer: Cigna Commercial |
$408.15
|
| Rate for Payer: First Health Commercial |
$467.16
|
| Rate for Payer: Humana Commercial |
$417.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$403.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$362.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$147.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$432.74
|
| Rate for Payer: Ohio Health Group HMO |
$368.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$98.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$63.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$152.44
|
| Rate for Payer: PHCS Commercial |
$472.08
|
|
|
8FR. ANGIO SEAL VIP 610131
|
Facility
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$10,631.52 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
|
|
8FR. ANGIO SEAL VIP 610131
|
Facility
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.72 |
| Max. Negotiated Rate |
$10,631.52 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
