|
JL 4.5 6F 100CM
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$395.49
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
JL 4.5 CATH 5F
|
Facility
|
OP
|
$168.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$161.35 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Anthem Medicaid |
$57.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.09
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: First Health Commercial |
$159.67
|
| Rate for Payer: Humana Commercial |
$142.86
|
| Rate for Payer: Humana KY Medicaid |
$57.80
|
| Rate for Payer: Kentucky WC Medicaid |
$58.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.90
|
| Rate for Payer: Ohio Health Group HMO |
$126.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.97
|
| Rate for Payer: PHCS Commercial |
$161.35
|
| Rate for Payer: United Healthcare All Payer |
$147.90
|
|
|
JL 4.5 CATH 5F
|
Facility
|
IP
|
$168.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$161.35 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.09
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: First Health Commercial |
$159.67
|
| Rate for Payer: Humana Commercial |
$142.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.90
|
| Rate for Payer: Ohio Health Group HMO |
$126.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.97
|
| Rate for Payer: PHCS Commercial |
$161.35
|
| Rate for Payer: United Healthcare All Payer |
$147.90
|
|
|
JL4 6FR 100CM
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL4 6FR 100CM
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL 4 CATH 5F
|
Facility
|
IP
|
$440.26
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$422.65 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.40
|
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Cigna Commercial |
$365.42
|
| Rate for Payer: First Health Commercial |
$418.25
|
| Rate for Payer: Humana Commercial |
$374.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.43
|
| Rate for Payer: Ohio Health Group HMO |
$330.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.78
|
| Rate for Payer: PHCS Commercial |
$422.65
|
| Rate for Payer: United Healthcare All Payer |
$387.43
|
|
|
JL 4 CATH 5F
|
Facility
|
OP
|
$440.26
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$422.65 |
| Rate for Payer: Aetna Commercial |
$339.00
|
| Rate for Payer: Anthem Medicaid |
$151.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.40
|
| Rate for Payer: Cash Price |
$220.13
|
| Rate for Payer: Cigna Commercial |
$365.42
|
| Rate for Payer: First Health Commercial |
$418.25
|
| Rate for Payer: Humana Commercial |
$374.22
|
| Rate for Payer: Humana KY Medicaid |
$151.41
|
| Rate for Payer: Kentucky WC Medicaid |
$152.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$361.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.43
|
| Rate for Payer: Ohio Health Group HMO |
$330.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$383.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.78
|
| Rate for Payer: PHCS Commercial |
$422.65
|
| Rate for Payer: United Healthcare All Payer |
$387.43
|
|
|
JL4 CATH ST 6F
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL4 CATH ST 6F
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL 4 GUIDE 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
|
|
|
JL 4 GUIDE 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
|
|
|
JL4 GUIDE 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
|
|
|
JL4 GUIDE 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
|
|
|
JL 5 6F 100CM
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL 5 6F 100CM
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL 5 CATH 5F
|
Facility
|
OP
|
$168.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$161.35 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Anthem Medicaid |
$57.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.09
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: First Health Commercial |
$159.67
|
| Rate for Payer: Humana Commercial |
$142.86
|
| Rate for Payer: Humana KY Medicaid |
$57.80
|
| Rate for Payer: Kentucky WC Medicaid |
$58.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.90
|
| Rate for Payer: Ohio Health Group HMO |
$126.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.97
|
| Rate for Payer: PHCS Commercial |
$161.35
|
| Rate for Payer: United Healthcare All Payer |
$147.90
|
|
|
JL 5 CATH 5F
|
Facility
|
IP
|
$168.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$161.35 |
| Rate for Payer: Aetna Commercial |
$129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.09
|
| Rate for Payer: Cash Price |
$84.04
|
| Rate for Payer: Cigna Commercial |
$139.50
|
| Rate for Payer: First Health Commercial |
$159.67
|
| Rate for Payer: Humana Commercial |
$142.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$137.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$147.90
|
| Rate for Payer: Ohio Health Group HMO |
$126.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$134.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.97
|
| Rate for Payer: PHCS Commercial |
$161.35
|
| Rate for Payer: United Healthcare All Payer |
$147.90
|
|
|
JL 5F 3.5 GUIDE
|
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
|
|
|
JL 5F 3.5 GUIDE
|
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
|
|
|
JL 6 6F 100CM
|
Facility
|
OP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem Medicaid |
$58.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Humana KY Medicaid |
$58.03
|
| Rate for Payer: Kentucky WC Medicaid |
$58.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL 6 6F 100CM
|
Facility
|
IP
|
$168.75
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.62 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$129.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$131.62
|
| Rate for Payer: Cash Price |
$84.38
|
| Rate for Payer: Cigna Commercial |
$140.06
|
| Rate for Payer: First Health Commercial |
$160.31
|
| Rate for Payer: Humana Commercial |
$143.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$138.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$124.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$148.50
|
| Rate for Payer: Ohio Health Group HMO |
$126.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$116.44
|
| Rate for Payer: PHCS Commercial |
$162.00
|
| Rate for Payer: United Healthcare All Payer |
$148.50
|
|
|
JL 6F 3.5 GUIDE
|
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
|
|
|
JL 6F 3.5 GUIDE
|
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
|
|
|
JOHN CUNNINGHAM ANTIBODY
|
Facility
|
OP
|
$2,018.00
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
30002076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$1,937.28 |
| Rate for Payer: Aetna Commercial |
$1,553.86
|
| Rate for Payer: Anthem Medicaid |
$16.89
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,620.45
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23.65
|
| Rate for Payer: CareSource Just4Me Medicare |
$16.89
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cigna Commercial |
$1,674.94
|
| Rate for Payer: First Health Commercial |
$1,917.10
|
| Rate for Payer: Humana Commercial |
$1,715.30
|
| Rate for Payer: Humana KY Medicaid |
$16.89
|
| Rate for Payer: Humana Medicare Advantage |
$16.89
|
| Rate for Payer: Kentucky WC Medicaid |
$17.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$20.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$17.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,392.42
|
| Rate for Payer: PHCS Commercial |
$1,937.28
|
| Rate for Payer: United Healthcare All Payer |
$1,775.84
|
|
|
JOHN CUNNINGHAM ANTIBODY
|
Facility
|
IP
|
$2,018.00
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
30002076
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,937.28 |
| Rate for Payer: Aetna Commercial |
$1,553.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,620.45
|
| Rate for Payer: Cash Price |
$1,009.00
|
| Rate for Payer: Cigna Commercial |
$1,674.94
|
| Rate for Payer: First Health Commercial |
$1,917.10
|
| Rate for Payer: Humana Commercial |
$1,715.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,614.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,392.42
|
| Rate for Payer: PHCS Commercial |
$1,937.28
|
| Rate for Payer: United Healthcare All Payer |
$1,775.84
|
|
