|
MPA 1 GUIDE CATH 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
|
|
|
MPA 1 GUIDE CATH 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
|
|
|
MPA-1 ST 6F 100CM
|
Facility
|
OP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
MPA-1 ST 6F 100CM
|
Facility
|
IP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
MPA-2 5FR 100CM
|
Facility
|
IP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
MPA-2 5FR 100CM
|
Facility
|
OP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
MPA 2 CATH 5F
|
Facility
|
IP
|
$162.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.80
|
| Rate for Payer: Cash Price |
$81.28
|
| Rate for Payer: Cigna Commercial |
$134.92
|
| Rate for Payer: First Health Commercial |
$154.43
|
| Rate for Payer: Humana Commercial |
$138.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.05
|
| Rate for Payer: Ohio Health Group HMO |
$121.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.39
|
| Rate for Payer: PHCS Commercial |
$156.06
|
| Rate for Payer: United Healthcare All Payer |
$143.05
|
|
|
MPA 2 CATH 5F
|
Facility
|
OP
|
$162.56
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$156.06 |
| Rate for Payer: Aetna Commercial |
$125.17
|
| Rate for Payer: Anthem Medicaid |
$55.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$126.80
|
| Rate for Payer: Cash Price |
$81.28
|
| Rate for Payer: Cigna Commercial |
$134.92
|
| Rate for Payer: First Health Commercial |
$154.43
|
| Rate for Payer: Humana Commercial |
$138.18
|
| Rate for Payer: Humana KY Medicaid |
$55.90
|
| Rate for Payer: Kentucky WC Medicaid |
$56.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$119.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.05
|
| Rate for Payer: Ohio Health Group HMO |
$121.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.39
|
| Rate for Payer: PHCS Commercial |
$156.06
|
| Rate for Payer: United Healthcare All Payer |
$143.05
|
|
|
MPB1 GUIDE CATH 6F
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
MPB1 GUIDE CATH 6F
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$748.80 |
| Rate for Payer: Aetna Commercial |
$600.60
|
| Rate for Payer: Anthem Medicaid |
$268.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$608.40
|
| Rate for Payer: Cash Price |
$390.00
|
| Rate for Payer: Cigna Commercial |
$647.40
|
| Rate for Payer: First Health Commercial |
$741.00
|
| Rate for Payer: Humana Commercial |
$663.00
|
| Rate for Payer: Humana KY Medicaid |
$268.24
|
| Rate for Payer: Kentucky WC Medicaid |
$270.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$639.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$575.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$234.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$273.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$686.40
|
| Rate for Payer: Ohio Health Group HMO |
$585.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$101.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.80
|
| Rate for Payer: PHCS Commercial |
$748.80
|
| Rate for Payer: United Healthcare All Payer |
$686.40
|
|
|
MPB2 CATH 5F 100CM 2SH
|
Facility
|
OP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
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
|
|
|
MPB2 CATH 5F 100CM 2SH
|
Facility
|
IP
|
$164.07
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
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
|
|
|
MPB 2 CATH 6F 100CM
|
Facility
|
IP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
MPB 2 CATH 6F 100CM
|
Facility
|
OP
|
$159.98
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$153.58 |
| Rate for Payer: Aetna Commercial |
$123.18
|
| Rate for Payer: Anthem Medicaid |
$55.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$124.78
|
| Rate for Payer: Cash Price |
$79.99
|
| Rate for Payer: Cigna Commercial |
$132.78
|
| Rate for Payer: First Health Commercial |
$151.98
|
| Rate for Payer: Humana Commercial |
$135.98
|
| Rate for Payer: Humana KY Medicaid |
$55.02
|
| Rate for Payer: Kentucky WC Medicaid |
$55.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$131.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$118.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$47.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$140.78
|
| Rate for Payer: Ohio Health Group HMO |
$119.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$49.59
|
| Rate for Payer: PHCS Commercial |
$153.58
|
| Rate for Payer: United Healthcare All Payer |
$140.78
|
|
|
MPB2 GUIDE CATH 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
|
|
|
MPB2 GUIDE CATH 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
|
|
|
MPFL T-ROPE SW-LK ANCHOR 3.9*
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
MPFL T-ROPE SW-LK ANCHOR 3.9*
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DYE
|
Professional
|
Both
|
$4,468.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$4,468.00 |
| Rate for Payer: Healthspan PPO |
$653.16
|
| Rate for Payer: Aetna Commercial |
$950.53
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,468.00
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$1,400.25
|
| Rate for Payer: Humana Medicaid |
$656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.78
|
| Rate for Payer: Molina Healthcare Passport |
$656.65
|
| Rate for Payer: Multiplan PHCS |
$2,680.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,127.60
|
| Rate for Payer: UHCCP Medicaid |
$1,563.80
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DYE
|
Facility
|
OP
|
$4,468.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem Medicaid |
$1,536.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Humana KY Medicaid |
$1,536.55
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,552.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DYE
|
Facility
|
IP
|
$4,468.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DY(P
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
610P0051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$1,400.25 |
| Rate for Payer: Aetna Commercial |
$950.53
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Medicare Advantage |
$250.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cash Price |
$125.00
|
| Rate for Payer: Cigna Commercial |
$1,400.25
|
| Rate for Payer: Healthspan PPO |
$653.16
|
| Rate for Payer: Humana Medicaid |
$656.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$114.75
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.78
|
| Rate for Payer: Molina Healthcare Passport |
$656.65
|
| Rate for Payer: Multiplan PHCS |
$150.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DY(T
|
Facility
|
IP
|
$4,218.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
610T0051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$548.34 |
| Max. Negotiated Rate |
$4,049.28 |
| Rate for Payer: Aetna Commercial |
$3,247.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.04
|
| Rate for Payer: Cash Price |
$2,109.00
|
| Rate for Payer: Cigna Commercial |
$3,500.94
|
| Rate for Payer: First Health Commercial |
$4,007.10
|
| Rate for Payer: Humana Commercial |
$3,585.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,458.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,112.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,265.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,711.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.58
|
| Rate for Payer: PHCS Commercial |
$4,049.28
|
| Rate for Payer: United Healthcare All Payer |
$3,711.84
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DY(T
|
Facility
|
OP
|
$4,218.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
610T0051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$332.56 |
| Max. Negotiated Rate |
$4,049.28 |
| Rate for Payer: Aetna Commercial |
$3,247.86
|
| Rate for Payer: Anthem Medicaid |
$1,450.57
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$332.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,290.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$465.58
|
| Rate for Payer: CareSource Just4Me Medicare |
$448.96
|
| Rate for Payer: Cash Price |
$2,109.00
|
| Rate for Payer: Cash Price |
$2,109.00
|
| Rate for Payer: Cigna Commercial |
$3,500.94
|
| Rate for Payer: First Health Commercial |
$4,007.10
|
| Rate for Payer: Humana Commercial |
$3,585.30
|
| Rate for Payer: Humana KY Medicaid |
$1,450.57
|
| Rate for Payer: Humana Medicare Advantage |
$332.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,465.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,458.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,112.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$399.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,479.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,711.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,163.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$843.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,307.58
|
| Rate for Payer: PHCS Commercial |
$4,049.28
|
| Rate for Payer: United Healthcare All Payer |
$3,711.84
|
|
|
MR ANGIOGRAPH NECK W/O&W/DYE
|
Facility
|
IP
|
$4,199.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
61000007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$545.87 |
| Max. Negotiated Rate |
$4,031.04 |
| Rate for Payer: Aetna Commercial |
$3,233.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,275.22
|
| Rate for Payer: Cash Price |
$2,099.50
|
| Rate for Payer: Cigna Commercial |
$3,485.17
|
| Rate for Payer: First Health Commercial |
$3,989.05
|
| Rate for Payer: Humana Commercial |
$3,569.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,443.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,098.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,259.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,695.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,149.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$839.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$545.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,301.69
|
| Rate for Payer: PHCS Commercial |
$4,031.04
|
| Rate for Payer: United Healthcare All Payer |
$3,695.12
|
|
