|
MPA 1 GUIDE CATH 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
|
|
|
MPA-1 ST 6F 100CM
|
Facility
|
OP
|
$163.69
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem Medicaid |
$56.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Humana KY Medicaid |
$56.29
|
| Rate for Payer: Kentucky WC Medicaid |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
MPA-1 ST 6F 100CM
|
Facility
|
IP
|
$163.69
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
MPA-2 5FR 100CM
|
Facility
|
OP
|
$163.69
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem Medicaid |
$56.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Humana KY Medicaid |
$56.29
|
| Rate for Payer: Kentucky WC Medicaid |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
MPA-2 5FR 100CM
|
Facility
|
IP
|
$163.69
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
MPA 2 CATH 5F
|
Facility
|
IP
|
$166.46
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial |
$128.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.84
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cigna Commercial |
$138.16
|
| Rate for Payer: First Health Commercial |
$158.14
|
| Rate for Payer: Humana Commercial |
$141.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.48
|
| Rate for Payer: Ohio Health Group HMO |
$124.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.86
|
| Rate for Payer: PHCS Commercial |
$159.80
|
| Rate for Payer: United Healthcare All Payer |
$146.48
|
|
|
MPA 2 CATH 5F
|
Facility
|
OP
|
$166.46
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$159.80 |
| Rate for Payer: Aetna Commercial |
$128.17
|
| Rate for Payer: Anthem Medicaid |
$57.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$129.84
|
| Rate for Payer: Cash Price |
$83.23
|
| Rate for Payer: Cigna Commercial |
$138.16
|
| Rate for Payer: First Health Commercial |
$158.14
|
| Rate for Payer: Humana Commercial |
$141.49
|
| Rate for Payer: Humana KY Medicaid |
$57.25
|
| Rate for Payer: Kentucky WC Medicaid |
$57.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$122.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.48
|
| Rate for Payer: Ohio Health Group HMO |
$124.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$133.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$114.86
|
| Rate for Payer: PHCS Commercial |
$159.80
|
| Rate for Payer: United Healthcare All Payer |
$146.48
|
|
|
MPB1 GUIDE CATH 6F
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
MPB1 GUIDE CATH 6F
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$616.00
|
| Rate for Payer: Anthem Medicaid |
$275.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$624.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cigna Commercial |
$664.00
|
| Rate for Payer: First Health Commercial |
$760.00
|
| Rate for Payer: Humana Commercial |
$680.00
|
| Rate for Payer: Humana KY Medicaid |
$275.12
|
| Rate for Payer: Kentucky WC Medicaid |
$277.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$656.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$590.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$280.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$704.00
|
| Rate for Payer: Ohio Health Group HMO |
$600.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$696.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.00
|
| Rate for Payer: PHCS Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Payer |
$704.00
|
|
|
MPB2 CATH 5F 100CM 2SH
|
Facility
|
IP
|
$440.10
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
MPB2 CATH 5F 100CM 2SH
|
Facility
|
OP
|
$440.10
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.03 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$338.88
|
| Rate for Payer: Anthem Medicaid |
$151.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$343.28
|
| Rate for Payer: Cash Price |
$220.05
|
| Rate for Payer: Cigna Commercial |
$365.28
|
| Rate for Payer: First Health Commercial |
$418.10
|
| Rate for Payer: Humana Commercial |
$374.08
|
| Rate for Payer: Humana KY Medicaid |
$151.35
|
| Rate for Payer: Kentucky WC Medicaid |
$152.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$360.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$324.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$154.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$387.29
|
| Rate for Payer: Ohio Health Group HMO |
$330.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$382.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$303.67
|
| Rate for Payer: PHCS Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Payer |
$387.29
|
|
|
MPB 2 CATH 6F 100CM
|
Facility
|
OP
|
$163.69
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem Medicaid |
$56.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Humana KY Medicaid |
$56.29
|
| Rate for Payer: Kentucky WC Medicaid |
$56.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
MPB 2 CATH 6F 100CM
|
Facility
|
IP
|
$163.69
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$157.14 |
| Rate for Payer: Aetna Commercial |
$126.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.68
|
| Rate for Payer: Cash Price |
$81.84
|
| Rate for Payer: Cigna Commercial |
$135.86
|
| Rate for Payer: First Health Commercial |
$155.51
|
| Rate for Payer: Humana Commercial |
$139.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$134.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$49.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$144.05
|
| Rate for Payer: Ohio Health Group HMO |
$122.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$130.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$112.95
|
| Rate for Payer: PHCS Commercial |
$157.14
|
| Rate for Payer: United Healthcare All Payer |
$144.05
|
|
|
MPB2 GUIDE CATH 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
|
|
|
MPB2 GUIDE CATH 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
|
|
|
MPFL T-ROPE SW-LK ANCHOR 3.9*
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
MPFL T-ROPE SW-LK ANCHOR 3.9*
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DYE
|
Facility
|
IP
|
$4,743.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,422.90 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$3,652.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,699.54
|
| Rate for Payer: Cash Price |
$2,371.50
|
| Rate for Payer: Cigna Commercial |
$3,936.69
|
| Rate for Payer: First Health Commercial |
$4,505.85
|
| Rate for Payer: Humana Commercial |
$4,031.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,889.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,500.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,422.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,173.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,557.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,794.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,126.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,272.67
|
| Rate for Payer: PHCS Commercial |
$4,553.28
|
| Rate for Payer: United Healthcare All Payer |
$4,173.84
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DYE
|
Professional
|
Both
|
$4,743.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$2,845.80 |
| Rate for Payer: Aetna Commercial |
$950.53
|
| Rate for Payer: Ambetter Exchange |
$300.55
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.66
|
| Rate for Payer: Cash Price |
$2,371.50
|
| Rate for Payer: Cash Price |
$2,371.50
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$300.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.78
|
| Rate for Payer: Molina Healthcare Passport |
$656.65
|
| Rate for Payer: Multiplan PHCS |
$2,845.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$390.71
|
| Rate for Payer: UHCCP Medicaid |
$1,660.05
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.55
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DYE
|
Facility
|
OP
|
$4,743.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
61000051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,553.28 |
| Rate for Payer: Aetna Commercial |
$3,652.11
|
| Rate for Payer: Anthem Medicaid |
$1,631.12
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,699.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,371.50
|
| Rate for Payer: Cash Price |
$2,371.50
|
| Rate for Payer: Cigna Commercial |
$3,936.69
|
| Rate for Payer: First Health Commercial |
$4,505.85
|
| Rate for Payer: Humana Commercial |
$4,031.55
|
| Rate for Payer: Humana KY Medicaid |
$1,631.12
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,647.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,889.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,500.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,663.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,173.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,557.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,794.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,126.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,272.67
|
| Rate for Payer: PHCS Commercial |
$4,553.28
|
| Rate for Payer: United Healthcare All Payer |
$4,173.84
|
|
|
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: Ambetter Exchange |
$300.55
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$300.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$360.66
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$300.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.55
|
| 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 |
$390.71
|
| Rate for Payer: UHCCP Medicaid |
$87.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$300.55
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DY(T
|
Facility
|
OP
|
$4,493.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
610T0051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,313.28 |
| Rate for Payer: Aetna Commercial |
$3,459.61
|
| Rate for Payer: Anthem Medicaid |
$1,545.14
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,246.50
|
| Rate for Payer: Cash Price |
$2,246.50
|
| Rate for Payer: Cigna Commercial |
$3,729.19
|
| Rate for Payer: First Health Commercial |
$4,268.35
|
| Rate for Payer: Humana Commercial |
$3,819.05
|
| Rate for Payer: Humana KY Medicaid |
$1,545.14
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,560.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,594.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,100.17
|
| Rate for Payer: PHCS Commercial |
$4,313.28
|
| Rate for Payer: United Healthcare All Payer |
$3,953.84
|
|
|
MR ANGIOGRAPH HEAD W/O&W/DY(T
|
Facility
|
IP
|
$4,493.00
|
|
|
Service Code
|
HCPCS 70546
|
| Hospital Charge Code |
610T0051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,347.90 |
| Max. Negotiated Rate |
$4,313.28 |
| Rate for Payer: Aetna Commercial |
$3,459.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.54
|
| Rate for Payer: Cash Price |
$2,246.50
|
| Rate for Payer: Cigna Commercial |
$3,729.19
|
| Rate for Payer: First Health Commercial |
$4,268.35
|
| Rate for Payer: Humana Commercial |
$3,819.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,953.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,594.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,908.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,100.17
|
| Rate for Payer: PHCS Commercial |
$4,313.28
|
| Rate for Payer: United Healthcare All Payer |
$3,953.84
|
|
|
MR ANGIOGRAPH NECK W/O&W/DYE
|
Facility
|
OP
|
$4,459.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
61000007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$329.98 |
| Max. Negotiated Rate |
$4,280.64 |
| Rate for Payer: Aetna Commercial |
$3,433.43
|
| Rate for Payer: Anthem Medicaid |
$1,533.45
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$329.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,478.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$461.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$445.47
|
| Rate for Payer: Cash Price |
$2,229.50
|
| Rate for Payer: Cash Price |
$2,229.50
|
| Rate for Payer: Cigna Commercial |
$3,700.97
|
| Rate for Payer: First Health Commercial |
$4,236.05
|
| Rate for Payer: Humana Commercial |
$3,790.15
|
| Rate for Payer: Humana KY Medicaid |
$1,533.45
|
| Rate for Payer: Humana Medicare Advantage |
$329.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,549.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,656.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,290.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$395.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,564.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,923.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,344.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,567.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,879.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,076.71
|
| Rate for Payer: PHCS Commercial |
$4,280.64
|
| Rate for Payer: United Healthcare All Payer |
$3,923.92
|
|
|
MR ANGIOGRAPH NECK W/O&W/DYE
|
Professional
|
Both
|
$4,459.00
|
|
|
Service Code
|
HCPCS 70549
|
| Hospital Charge Code |
61000007
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$114.23 |
| Max. Negotiated Rate |
$2,675.40 |
| Rate for Payer: Aetna Commercial |
$950.53
|
| Rate for Payer: Ambetter Exchange |
$315.66
|
| Rate for Payer: Anthem Medicaid |
$656.65
|
| Rate for Payer: Buckeye Individual/Medicaid |
$315.66
|
| Rate for Payer: Buckeye Medicare Advantage |
$315.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$378.79
|
| Rate for Payer: Cash Price |
$2,229.50
|
| Rate for Payer: Cash Price |
$2,229.50
|
| Rate for Payer: Cigna Commercial |
$1,399.70
|
| 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 |
$114.23
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$315.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$315.66
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$669.78
|
| Rate for Payer: Molina Healthcare Passport |
$656.65
|
| Rate for Payer: Multiplan PHCS |
$2,675.40
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$410.36
|
| Rate for Payer: UHCCP Medicaid |
$1,560.65
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$663.22
|
| Rate for Payer: Wellcare Medicare Advantage |
$315.66
|
|
