|
JOURNY VISIONAIR MRI TIB BLCKL
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
JR 3.5 6F 100CM
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
JR 3.5 6F 100CM
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
JR 3 GUIDE CATHETER 6F
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 3 GUIDE CATHETER 6F
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 4 CATH 5F
|
Facility
|
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| 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
|
| Rate for Payer: United Healthcare All Payer |
$144.38
|
|
|
JR 4 CATH 5F
|
Facility
|
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$157.51 |
| 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
|
|
|
JR 4 GUIDE 125CM
|
Facility
|
IP
|
$1,879.20
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$1,804.03 |
| Rate for Payer: Aetna Commercial |
$1,446.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.78
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$1,559.74
|
| Rate for Payer: First Health Commercial |
$1,785.24
|
| Rate for Payer: Humana Commercial |
$1,597.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,409.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.55
|
| Rate for Payer: PHCS Commercial |
$1,804.03
|
| Rate for Payer: United Healthcare All Payer |
$1,653.70
|
|
|
JR 4 GUIDE 125CM
|
Facility
|
OP
|
$1,879.20
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$1,804.03 |
| Rate for Payer: Aetna Commercial |
$1,446.98
|
| Rate for Payer: Anthem Medicaid |
$646.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.78
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$1,559.74
|
| Rate for Payer: First Health Commercial |
$1,785.24
|
| Rate for Payer: Humana Commercial |
$1,597.32
|
| Rate for Payer: Humana KY Medicaid |
$646.26
|
| Rate for Payer: Kentucky WC Medicaid |
$652.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$659.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,409.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.55
|
| Rate for Payer: PHCS Commercial |
$1,804.03
|
| Rate for Payer: United Healthcare All Payer |
$1,653.70
|
|
|
JR 4 GUIDE 6F 100CM
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 4 GUIDE 6F 100CM
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 4 GUIDE 6F 110CM
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 4 GUIDE 6F 110CM
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 4 GUIDE 8FR
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
JR 4 GUIDE 8FR
|
Facility
|
OP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
JR4 W/SH 6F 100CM CATH LAUNCHR
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR4 W/SH 6F 100CM CATH LAUNCHR
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 5 5F 100CM
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
JR 5 5F 100CM
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
JR 5 6F 100CM
|
Facility
|
IP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
JR 5 6F 100CM
|
Facility
|
OP
|
$164.70
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.41 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Aetna Commercial |
$126.82
|
| Rate for Payer: Anthem Medicaid |
$56.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$128.47
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna Commercial |
$136.70
|
| Rate for Payer: First Health Commercial |
$156.46
|
| Rate for Payer: Humana Commercial |
$140.00
|
| Rate for Payer: Humana KY Medicaid |
$56.64
|
| Rate for Payer: Kentucky WC Medicaid |
$57.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$135.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$121.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.94
|
| Rate for Payer: Ohio Health Group HMO |
$123.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.06
|
| Rate for Payer: PHCS Commercial |
$158.11
|
| Rate for Payer: United Healthcare All Payer |
$144.94
|
|
|
JR 5F 4.0
|
Facility
|
OP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem Medicaid |
$266.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Humana KY Medicaid |
$266.69
|
| Rate for Payer: Kentucky WC Medicaid |
$269.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 5F 4.0
|
Facility
|
IP
|
$775.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$744.48 |
| Rate for Payer: Aetna Commercial |
$597.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$604.89
|
| Rate for Payer: Cash Price |
$387.75
|
| Rate for Payer: Cigna Commercial |
$643.66
|
| Rate for Payer: First Health Commercial |
$736.72
|
| Rate for Payer: Humana Commercial |
$659.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$635.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.44
|
| Rate for Payer: Ohio Health Group HMO |
$581.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$155.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$240.40
|
| Rate for Payer: PHCS Commercial |
$744.48
|
| Rate for Payer: United Healthcare All Payer |
$682.44
|
|
|
JR 5F 4.5
|
Facility
|
IP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
|
JR 5F 4.5
|
Facility
|
OP
|
$784.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$753.12 |
| Rate for Payer: Aetna Commercial |
$604.06
|
| Rate for Payer: Anthem Medicaid |
$269.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$611.91
|
| Rate for Payer: Cash Price |
$392.25
|
| Rate for Payer: Cigna Commercial |
$651.14
|
| Rate for Payer: First Health Commercial |
$745.28
|
| Rate for Payer: Humana Commercial |
$666.82
|
| Rate for Payer: Humana KY Medicaid |
$269.79
|
| Rate for Payer: Kentucky WC Medicaid |
$272.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$643.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$578.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$235.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$275.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$690.36
|
| Rate for Payer: Ohio Health Group HMO |
$588.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$243.20
|
| Rate for Payer: PHCS Commercial |
$753.12
|
| Rate for Payer: United Healthcare All Payer |
$690.36
|
|
