|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
OP
|
$4,882.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
761T2469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$634.66 |
| Max. Negotiated Rate |
$4,686.72 |
| Rate for Payer: Aetna Commercial |
$3,759.14
|
| Rate for Payer: Anthem Medicaid |
$1,678.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.96
|
| Rate for Payer: Cash Price |
$2,441.00
|
| Rate for Payer: Cigna Commercial |
$4,052.06
|
| Rate for Payer: First Health Commercial |
$4,637.90
|
| Rate for Payer: Humana Commercial |
$4,149.70
|
| Rate for Payer: Humana KY Medicaid |
$1,678.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,696.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.42
|
| Rate for Payer: PHCS Commercial |
$4,686.72
|
| Rate for Payer: United Healthcare All Payer |
$4,296.16
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Professional
|
Both
|
$5,132.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
76102469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.37 |
| Max. Negotiated Rate |
$5,132.00 |
| Rate for Payer: Aetna Commercial |
$457.27
|
| Rate for Payer: Anthem Medicaid |
$200.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,132.00
|
| Rate for Payer: Cash Price |
$2,566.00
|
| Rate for Payer: Cash Price |
$2,566.00
|
| Rate for Payer: Cigna Commercial |
$431.15
|
| Rate for Payer: Healthspan PPO |
$420.04
|
| Rate for Payer: Humana Medicaid |
$200.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$127.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.09
|
| Rate for Payer: Molina Healthcare Passport |
$200.09
|
| Rate for Payer: Multiplan PHCS |
$3,079.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,592.40
|
| Rate for Payer: UHCCP Medicaid |
$1,796.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.09
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
761P2469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$457.27 |
| Rate for Payer: Aetna Commercial |
$457.27
|
| Rate for Payer: Anthem Medicaid |
$200.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$431.15
|
| Rate for Payer: Healthspan PPO |
$420.04
|
| Rate for Payer: Humana Medicaid |
$200.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$127.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$204.09
|
| Rate for Payer: Molina Healthcare Passport |
$200.09
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$202.09
|
|
|
INTRAVASC U/S CORN VESSEL/GRAF
|
Facility
|
OP
|
$5,132.00
|
|
|
Service Code
|
HCPCS 92978
|
| Hospital Charge Code |
76102469
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$667.16 |
| Max. Negotiated Rate |
$4,926.72 |
| Rate for Payer: Aetna Commercial |
$3,951.64
|
| Rate for Payer: Anthem Medicaid |
$1,764.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,002.96
|
| Rate for Payer: Cash Price |
$2,566.00
|
| Rate for Payer: Cigna Commercial |
$4,259.56
|
| Rate for Payer: First Health Commercial |
$4,875.40
|
| Rate for Payer: Humana Commercial |
$4,362.20
|
| Rate for Payer: Humana KY Medicaid |
$1,764.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,782.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,208.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,787.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,800.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,516.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,849.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,026.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,590.92
|
| Rate for Payer: PHCS Commercial |
$4,926.72
|
| Rate for Payer: United Healthcare All Payer |
$4,516.16
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
76101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$13,318.61 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem Medicaid |
$173.67
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$9,513.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$13,318.61
|
| Rate for Payer: CareSource Just4Me Medicare |
$12,842.94
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Humana KY Medicaid |
$173.67
|
| Rate for Payer: Humana Medicare Advantage |
$9,513.29
|
| Rate for Payer: Kentucky WC Medicaid |
$175.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$11,415.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$177.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.55
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
76101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.15 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$242.15
|
| Rate for Payer: Anthem Medicaid |
$242.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.00
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$496.05
|
| Rate for Payer: Humana Medicaid |
$242.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.41
|
| Rate for Payer: Molina Healthcare Passport |
$242.56
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$353.50
|
| Rate for Payer: UHCCP Medicaid |
$254.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.99
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem Medicaid |
$2,544.52
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Humana KY Medicaid |
$2,544.52
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
76101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$595.20 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$186.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
76101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$6,919.70 |
| Rate for Payer: Aetna Commercial |
$477.40
|
| Rate for Payer: Anthem Medicaid |
$213.22
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,942.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$483.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,919.70
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,672.56
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$514.60
|
| Rate for Payer: First Health Commercial |
$589.00
|
| Rate for Payer: Humana Commercial |
$527.00
|
| Rate for Payer: Humana KY Medicaid |
$213.22
|
| Rate for Payer: Humana Medicare Advantage |
$4,942.64
|
| Rate for Payer: Kentucky WC Medicaid |
$215.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$508.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$457.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,931.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$545.60
|
| Rate for Payer: Ohio Health Group HMO |
$465.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$80.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$192.20
|
| Rate for Payer: PHCS Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Payer |
$545.60
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
76101516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.65 |
| Max. Negotiated Rate |
$484.80 |
| Rate for Payer: Aetna Commercial |
$388.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$393.90
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$419.15
|
| Rate for Payer: First Health Commercial |
$479.75
|
| Rate for Payer: Humana Commercial |
$429.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$414.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$372.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$151.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$444.40
|
| Rate for Payer: Ohio Health Group HMO |
$378.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$101.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$65.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$156.55
|
| Rate for Payer: PHCS Commercial |
$484.80
|
| Rate for Payer: United Healthcare All Payer |
$444.40
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
76101515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.71
|
| Rate for Payer: Anthem Medicaid |
$177.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$362.36
|
| Rate for Payer: Humana Medicaid |
$177.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$281.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.67
|
| Rate for Payer: Molina Healthcare Passport |
$177.13
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$195.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.90
|
|
|
INTRO CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$7,399.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
48100033
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$7,103.04 |
| Rate for Payer: Aetna Commercial |
$5,697.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,771.22
|
| Rate for Payer: Cash Price |
$3,699.50
|
| Rate for Payer: Cigna Commercial |
$6,141.17
|
| Rate for Payer: First Health Commercial |
$7,029.05
|
| Rate for Payer: Humana Commercial |
$6,289.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,067.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,460.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,511.12
|
| Rate for Payer: Ohio Health Group HMO |
$5,549.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,479.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$961.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,293.69
|
| Rate for Payer: PHCS Commercial |
$7,103.04
|
| Rate for Payer: United Healthcare All Payer |
$6,511.12
|
|
|
INTRO CATH DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 36902
|
| Hospital Charge Code |
761P1515
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.13 |
| Max. Negotiated Rate |
$620.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.71
|
| Rate for Payer: Anthem Medicaid |
$177.13
|
| Rate for Payer: Buckeye Medicare Advantage |
$620.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cash Price |
$310.00
|
| Rate for Payer: Cigna Commercial |
$362.36
|
| Rate for Payer: Humana Medicaid |
$177.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$281.12
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$180.67
|
| Rate for Payer: Molina Healthcare Passport |
$177.13
|
| Rate for Payer: Multiplan PHCS |
$372.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$434.00
|
| Rate for Payer: UHCCP Medicaid |
$195.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$178.90
|
|
|
INTRO CATH DIALYSIS CIRCUIT(P
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 36903
|
| Hospital Charge Code |
761P1516
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$242.15 |
| Max. Negotiated Rate |
$505.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$242.15
|
| Rate for Payer: Anthem Medicaid |
$242.56
|
| Rate for Payer: Buckeye Medicare Advantage |
$505.00
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cash Price |
$252.50
|
| Rate for Payer: Cigna Commercial |
$496.05
|
| Rate for Payer: Humana Medicaid |
$242.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$384.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$247.41
|
| Rate for Payer: Molina Healthcare Passport |
$242.56
|
| Rate for Payer: Multiplan PHCS |
$303.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$353.50
|
| Rate for Payer: UHCCP Medicaid |
$254.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$244.99
|
|
|
INTRODCR MICRA 23F 55.7CM HYDR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
|
|
INTRODCR MICRA 23F 55.7CM HYDR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODCR OPTISEAL GLBL 7FR 13C
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODCR OPTISEAL GLBL 7FR 13C
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
|
|
INTRODCR SAFESHEATH 9.5FR SS95
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
INTRODCR SAFESHEATH 9.5FR SS95
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
27000112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
|
|
INTRODUCE C-CDIS-4.0-15 BERCI
|
Facility
|
OP
|
$1,587.05
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.32 |
| Max. Negotiated Rate |
$1,523.57 |
| Rate for Payer: Aetna Commercial |
$1,222.03
|
| Rate for Payer: Anthem Medicaid |
$545.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,237.90
|
| Rate for Payer: Cash Price |
$793.52
|
| Rate for Payer: Cigna Commercial |
$1,317.25
|
| Rate for Payer: First Health Commercial |
$1,507.70
|
| Rate for Payer: Humana Commercial |
$1,348.99
|
| Rate for Payer: Humana KY Medicaid |
$545.79
|
| Rate for Payer: Kentucky WC Medicaid |
$551.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,301.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,171.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$556.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,396.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,190.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.99
|
| Rate for Payer: PHCS Commercial |
$1,523.57
|
| Rate for Payer: United Healthcare All Payer |
$1,396.60
|
|
|
INTRODUCE C-CDIS-4.0-15 BERCI
|
Facility
|
IP
|
$1,587.05
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.32 |
| Max. Negotiated Rate |
$1,523.57 |
| Rate for Payer: Aetna Commercial |
$1,222.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,237.90
|
| Rate for Payer: Cash Price |
$793.52
|
| Rate for Payer: Cigna Commercial |
$1,317.25
|
| Rate for Payer: First Health Commercial |
$1,507.70
|
| Rate for Payer: Humana Commercial |
$1,348.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,301.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,171.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,396.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,190.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$491.99
|
| Rate for Payer: PHCS Commercial |
$1,523.57
|
| Rate for Payer: United Healthcare All Payer |
$1,396.60
|
|
|
INTRODUCER 10FR 7010
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
INTRODUCER 10FR 7010
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
INTRODUCER 10FR VIK10S1
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
27000113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
