|
ART 3.5 GUIDE CATH 6FR
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
ART 3.5 GUIDE CATH 7FR
|
Facility
|
OP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 3.5 GUIDE CATH 7FR
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 3.5 GUIDE CATH SIDE HOLES
|
Facility
|
OP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$373.65
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$373.65
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Kentucky WC Medicaid |
$377.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
ART 3.5 GUIDE CATH SIDE HOLES
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 3 GUID CATH W/SIDE HOLS 6F
|
Facility
|
IP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
ART 3 GUID CATH W/SIDE HOLS 6F
|
Facility
|
OP
|
$1,086.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$1,043.04 |
| Rate for Payer: Aetna Commercial |
$836.60
|
| Rate for Payer: Anthem Medicaid |
$373.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$847.47
|
| Rate for Payer: Cash Price |
$543.25
|
| Rate for Payer: Cigna Commercial |
$901.80
|
| Rate for Payer: First Health Commercial |
$1,032.18
|
| Rate for Payer: Humana Commercial |
$923.52
|
| Rate for Payer: Humana KY Medicaid |
$373.65
|
| Rate for Payer: Kentucky WC Medicaid |
$377.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$890.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$801.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$956.12
|
| Rate for Payer: Ohio Health Group HMO |
$814.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$336.82
|
| Rate for Payer: PHCS Commercial |
$1,043.04
|
| Rate for Payer: United Healthcare All Payer |
$956.12
|
|
|
ART 3 GUID CATH W/SIDE HOLS 7F
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 3 GUID CATH W/SIDE HOLS 7F
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 3 GUIDE CATH 6FR
|
Facility
|
OP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 3 GUIDE CATH 6FR
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 3 GUIDE CATH 7FR
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 3 GUIDE CATH 7FR
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4.0 GUIDE 8FR
|
Facility
|
IP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 4.0 GUIDE 8FR
|
Facility
|
OP
|
$811.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.50 |
| Max. Negotiated Rate |
$779.04 |
| Rate for Payer: Aetna Commercial |
$624.86
|
| Rate for Payer: Anthem Medicaid |
$279.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$632.97
|
| Rate for Payer: Cash Price |
$405.75
|
| Rate for Payer: Cigna Commercial |
$673.54
|
| Rate for Payer: First Health Commercial |
$770.92
|
| Rate for Payer: Humana Commercial |
$689.78
|
| Rate for Payer: Humana KY Medicaid |
$279.07
|
| Rate for Payer: Kentucky WC Medicaid |
$281.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$665.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$598.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$243.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$284.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$714.12
|
| Rate for Payer: Ohio Health Group HMO |
$608.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$162.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$105.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$251.56
|
| Rate for Payer: PHCS Commercial |
$779.04
|
| Rate for Payer: United Healthcare All Payer |
$714.12
|
|
|
ART 4.5 GUID CATH SIDE HOLS 7F
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4.5 GUID CATH SIDE HOLS 7F
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4.5 GUIDE CATH 7FR
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4.5 GUIDE CATH 7FR
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4 GUID CATH W/SIDE HOLS 7F
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4 GUID CATH W/SIDE HOLS 7F
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4 GUIDE CATH 7FR
|
Facility
|
OP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem Medicaid |
$370.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Humana KY Medicaid |
$370.69
|
| Rate for Payer: Kentucky WC Medicaid |
$374.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$378.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ART 4 GUIDE CATH 7FR
|
Facility
|
IP
|
$1,077.90
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.13 |
| Max. Negotiated Rate |
$1,034.78 |
| Rate for Payer: Aetna Commercial |
$829.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$840.76
|
| Rate for Payer: Cash Price |
$538.95
|
| Rate for Payer: Cigna Commercial |
$894.66
|
| Rate for Payer: First Health Commercial |
$1,024.00
|
| Rate for Payer: Humana Commercial |
$916.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$883.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$795.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$323.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$948.55
|
| Rate for Payer: Ohio Health Group HMO |
$808.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$215.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$334.15
|
| Rate for Payer: PHCS Commercial |
$1,034.78
|
| Rate for Payer: United Healthcare All Payer |
$948.55
|
|
|
ARTANE(TRIHEXYPHENIDY 2MG/1TAB
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 70954021210
|
| Hospital Charge Code |
25000256
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Anthem Medicaid |
$1.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Humana KY Medicaid |
$1.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
|
ARTANE(TRIHEXYPHENIDY 2MG/1TAB
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 70954021210
|
| Hospital Charge Code |
25000256
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.39
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna Commercial |
$3.61
|
| Rate for Payer: First Health Commercial |
$4.13
|
| Rate for Payer: Humana Commercial |
$3.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.83
|
| Rate for Payer: Ohio Health Group HMO |
$3.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$0.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$0.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1.35
|
| Rate for Payer: PHCS Commercial |
$4.18
|
| Rate for Payer: United Healthcare All Payer |
$3.83
|
|
