|
JOURNY VISIONAIR MRI TIB BLCKL
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
JR 3.5 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
|
|
|
JR 3.5 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
|
|
|
JR 3 GUIDE CATHETER 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
|
|
|
JR 3 GUIDE CATHETER 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
|
|
|
JR 4 CATH 5F
|
Facility
|
IP
|
$440.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
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
|
|
|
JR 4 CATH 5F
|
Facility
|
OP
|
$440.26
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
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
|
|
|
JR 4 GUIDE 125CM
|
Facility
|
IP
|
$1,874.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.37 |
| Max. Negotiated Rate |
$1,799.58 |
| Rate for Payer: Aetna Commercial |
$1,443.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.16
|
| Rate for Payer: Cash Price |
$937.28
|
| Rate for Payer: Cigna Commercial |
$1,555.88
|
| Rate for Payer: First Health Commercial |
$1,780.83
|
| Rate for Payer: Humana Commercial |
$1,593.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.45
|
| Rate for Payer: PHCS Commercial |
$1,799.58
|
| Rate for Payer: United Healthcare All Payer |
$1,649.61
|
|
|
JR 4 GUIDE 125CM
|
Facility
|
OP
|
$1,874.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.37 |
| Max. Negotiated Rate |
$1,799.58 |
| Rate for Payer: Aetna Commercial |
$1,443.41
|
| Rate for Payer: Anthem Medicaid |
$644.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.16
|
| Rate for Payer: Cash Price |
$937.28
|
| Rate for Payer: Cigna Commercial |
$1,555.88
|
| Rate for Payer: First Health Commercial |
$1,780.83
|
| Rate for Payer: Humana Commercial |
$1,593.38
|
| Rate for Payer: Humana KY Medicaid |
$644.66
|
| Rate for Payer: Kentucky WC Medicaid |
$651.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,293.45
|
| Rate for Payer: PHCS Commercial |
$1,799.58
|
| Rate for Payer: United Healthcare All Payer |
$1,649.61
|
|
|
JR 4 GUIDE 6F 100CM
|
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
|
|
|
JR 4 GUIDE 6F 100CM
|
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
|
|
|
JR 4 GUIDE 6F 110CM
|
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
|
|
|
JR 4 GUIDE 6F 110CM
|
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
|
|
|
JR 4 GUIDE 8FR
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem Medicaid |
$287.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Humana KY Medicaid |
$287.16
|
| Rate for Payer: Kentucky WC Medicaid |
$290.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$292.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
JR 4 GUIDE 8FR
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$801.60 |
| Rate for Payer: Aetna Commercial |
$642.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$651.30
|
| Rate for Payer: Cash Price |
$417.50
|
| Rate for Payer: Cigna Commercial |
$693.05
|
| Rate for Payer: First Health Commercial |
$793.25
|
| Rate for Payer: Humana Commercial |
$709.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$684.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$616.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$250.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$734.80
|
| Rate for Payer: Ohio Health Group HMO |
$626.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$668.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.15
|
| Rate for Payer: PHCS Commercial |
$801.60
|
| Rate for Payer: United Healthcare All Payer |
$734.80
|
|
|
JR4 W/SH 6F 100CM CATH LAUNCHR
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
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
|
|
|
JR4 W/SH 6F 100CM CATH LAUNCHR
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
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
|
|
|
JR 5 5F 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
|
|
|
JR 5 5F 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
|
|
|
JR 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
|
|
|
JR 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
|
|
|
JR 5F 4.0
|
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
|
|
|
JR 5F 4.0
|
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
|
|
|
JR 5F 4.5
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
|
JR 5F 4.5
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.50 |
| Max. Negotiated Rate |
$772.80 |
| Rate for Payer: Aetna Commercial |
$619.85
|
| Rate for Payer: Anthem Medicaid |
$276.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$627.90
|
| Rate for Payer: Cash Price |
$402.50
|
| Rate for Payer: Cigna Commercial |
$668.15
|
| Rate for Payer: First Health Commercial |
$764.75
|
| Rate for Payer: Humana Commercial |
$684.25
|
| Rate for Payer: Humana KY Medicaid |
$276.84
|
| Rate for Payer: Kentucky WC Medicaid |
$279.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$660.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$594.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$241.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$282.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$708.40
|
| Rate for Payer: Ohio Health Group HMO |
$603.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$700.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.45
|
| Rate for Payer: PHCS Commercial |
$772.80
|
| Rate for Payer: United Healthcare All Payer |
$708.40
|
|
