|
ARTEGRAFT BOVINE 5MM*30CM
|
Facility
|
OP
|
$7,212.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.67 |
| Max. Negotiated Rate |
$6,924.34 |
| Rate for Payer: Aetna Commercial |
$5,553.89
|
| Rate for Payer: Anthem Medicaid |
$2,480.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,626.02
|
| Rate for Payer: Cash Price |
$3,606.43
|
| Rate for Payer: Cigna Commercial |
$5,986.67
|
| Rate for Payer: First Health Commercial |
$6,852.21
|
| Rate for Payer: Humana Commercial |
$6,130.92
|
| Rate for Payer: Humana KY Medicaid |
$2,480.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,505.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,914.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,323.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,163.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,530.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,347.31
|
| Rate for Payer: Ohio Health Group HMO |
$5,409.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,442.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,235.98
|
| Rate for Payer: PHCS Commercial |
$6,924.34
|
| Rate for Payer: United Healthcare All Payer |
$6,347.31
|
|
|
ARTEGRAFT BOVINE 5MM X 45CM
|
Facility
|
IP
|
$16,400.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.05 |
| Max. Negotiated Rate |
$15,744.38 |
| Rate for Payer: Aetna Commercial |
$12,628.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,792.31
|
| Rate for Payer: Cash Price |
$8,200.20
|
| Rate for Payer: Cigna Commercial |
$13,612.33
|
| Rate for Payer: First Health Commercial |
$15,580.38
|
| Rate for Payer: Humana Commercial |
$13,940.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,448.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,103.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,920.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,432.35
|
| Rate for Payer: Ohio Health Group HMO |
$12,300.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,132.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,084.12
|
| Rate for Payer: PHCS Commercial |
$15,744.38
|
| Rate for Payer: United Healthcare All Payer |
$14,432.35
|
|
|
ARTEGRAFT BOVINE 5MM X 45CM
|
Facility
|
OP
|
$16,400.40
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,132.05 |
| Max. Negotiated Rate |
$15,744.38 |
| Rate for Payer: Aetna Commercial |
$12,628.31
|
| Rate for Payer: Anthem Medicaid |
$5,640.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,792.31
|
| Rate for Payer: Cash Price |
$8,200.20
|
| Rate for Payer: Cigna Commercial |
$13,612.33
|
| Rate for Payer: First Health Commercial |
$15,580.38
|
| Rate for Payer: Humana Commercial |
$13,940.34
|
| Rate for Payer: Humana KY Medicaid |
$5,640.10
|
| Rate for Payer: Kentucky WC Medicaid |
$5,697.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,448.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,103.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,920.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,753.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,432.35
|
| Rate for Payer: Ohio Health Group HMO |
$12,300.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,280.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,132.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,084.12
|
| Rate for Payer: PHCS Commercial |
$15,744.38
|
| Rate for Payer: United Healthcare All Payer |
$14,432.35
|
|
|
ARTEGRAFT BOVINE 7MM*15CM
|
Facility
|
OP
|
$4,016.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.14 |
| Max. Negotiated Rate |
$3,855.84 |
| Rate for Payer: Aetna Commercial |
$3,092.70
|
| Rate for Payer: Anthem Medicaid |
$1,381.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,132.87
|
| Rate for Payer: Cash Price |
$2,008.25
|
| Rate for Payer: Cigna Commercial |
$3,333.70
|
| Rate for Payer: First Health Commercial |
$3,815.68
|
| Rate for Payer: Humana Commercial |
$3,414.02
|
| Rate for Payer: Humana KY Medicaid |
$1,381.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,395.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,293.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,204.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,408.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,534.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,012.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$803.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.12
|
| Rate for Payer: PHCS Commercial |
$3,855.84
|
| Rate for Payer: United Healthcare All Payer |
$3,534.52
|
|
|
ARTEGRAFT BOVINE 7MM*15CM
|
Facility
|
IP
|
$4,016.50
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.14 |
| Max. Negotiated Rate |
$3,855.84 |
| Rate for Payer: Aetna Commercial |
$3,092.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,132.87
|
| Rate for Payer: Cash Price |
$2,008.25
|
| Rate for Payer: Cigna Commercial |
$3,333.70
|
| Rate for Payer: First Health Commercial |
$3,815.68
|
| Rate for Payer: Humana Commercial |
$3,414.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,293.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,204.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,534.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,012.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$803.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.12
|
| Rate for Payer: PHCS Commercial |
$3,855.84
|
| Rate for Payer: United Healthcare All Payer |
$3,534.52
|
|
|
ARTEGRAFT BOVINE 7MM*30CM
|
Facility
|
OP
|
$6,957.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.46 |
| Max. Negotiated Rate |
$6,679.06 |
| Rate for Payer: Aetna Commercial |
$5,357.16
|
| Rate for Payer: Anthem Medicaid |
$2,392.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,426.73
|
| Rate for Payer: Cash Price |
$3,478.68
|
| Rate for Payer: Cigna Commercial |
$5,774.60
|
| Rate for Payer: First Health Commercial |
$6,609.48
|
| Rate for Payer: Humana Commercial |
$5,913.75
|
| Rate for Payer: Humana KY Medicaid |
$2,392.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,416.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,705.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,134.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,440.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,122.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,218.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.78
|
| Rate for Payer: PHCS Commercial |
$6,679.06
|
| Rate for Payer: United Healthcare All Payer |
$6,122.47
|
|
|
ARTEGRAFT BOVINE 7MM*30CM
|
Facility
|
IP
|
$6,957.35
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$904.46 |
| Max. Negotiated Rate |
$6,679.06 |
| Rate for Payer: Aetna Commercial |
$5,357.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,426.73
|
| Rate for Payer: Cash Price |
$3,478.68
|
| Rate for Payer: Cigna Commercial |
$5,774.60
|
| Rate for Payer: First Health Commercial |
$6,609.48
|
| Rate for Payer: Humana Commercial |
$5,913.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,705.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,134.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,087.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,122.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,218.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$904.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.78
|
| Rate for Payer: PHCS Commercial |
$6,679.06
|
| Rate for Payer: United Healthcare All Payer |
$6,122.47
|
|
|
ARTEGRAFT BOVINE 7MM*50CM
|
Facility
|
OP
|
$10,059.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,307.78 |
| Max. Negotiated Rate |
$9,657.46 |
| Rate for Payer: Aetna Commercial |
$7,746.08
|
| Rate for Payer: Anthem Medicaid |
$3,459.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,846.68
|
| Rate for Payer: Cash Price |
$5,029.92
|
| Rate for Payer: Cigna Commercial |
$8,349.68
|
| Rate for Payer: First Health Commercial |
$9,556.86
|
| Rate for Payer: Humana Commercial |
$8,550.87
|
| Rate for Payer: Humana KY Medicaid |
$3,459.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,494.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,249.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,424.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,017.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,529.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,852.67
|
| Rate for Payer: Ohio Health Group HMO |
$7,544.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,011.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,307.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,118.55
|
| Rate for Payer: PHCS Commercial |
$9,657.46
|
| Rate for Payer: United Healthcare All Payer |
$8,852.67
|
|
|
ARTEGRAFT BOVINE 7MM*50CM
|
Facility
|
IP
|
$10,059.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,307.78 |
| Max. Negotiated Rate |
$9,657.46 |
| Rate for Payer: Aetna Commercial |
$7,746.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,846.68
|
| Rate for Payer: Cash Price |
$5,029.92
|
| Rate for Payer: Cigna Commercial |
$8,349.68
|
| Rate for Payer: First Health Commercial |
$9,556.86
|
| Rate for Payer: Humana Commercial |
$8,550.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,249.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,424.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,017.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,852.67
|
| Rate for Payer: Ohio Health Group HMO |
$7,544.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,011.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,307.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,118.55
|
| Rate for Payer: PHCS Commercial |
$9,657.46
|
| Rate for Payer: United Healthcare All Payer |
$8,852.67
|
|
|
ARTEGRAFT BOVINE 8MM*33CM
|
Facility
|
IP
|
$10,705.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,391.76 |
| Max. Negotiated Rate |
$10,277.62 |
| Rate for Payer: Aetna Commercial |
$8,243.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,350.56
|
| Rate for Payer: Cash Price |
$5,352.92
|
| Rate for Payer: Cigna Commercial |
$8,885.86
|
| Rate for Payer: First Health Commercial |
$10,170.56
|
| Rate for Payer: Humana Commercial |
$9,099.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,778.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,900.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,211.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,421.15
|
| Rate for Payer: Ohio Health Group HMO |
$8,029.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,318.81
|
| Rate for Payer: PHCS Commercial |
$10,277.62
|
| Rate for Payer: United Healthcare All Payer |
$9,421.15
|
|
|
ARTEGRAFT BOVINE 8MM*33CM
|
Facility
|
OP
|
$10,705.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,391.76 |
| Max. Negotiated Rate |
$10,277.62 |
| Rate for Payer: Aetna Commercial |
$8,243.50
|
| Rate for Payer: Anthem Medicaid |
$3,681.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,350.56
|
| Rate for Payer: Cash Price |
$5,352.92
|
| Rate for Payer: Cigna Commercial |
$8,885.86
|
| Rate for Payer: First Health Commercial |
$10,170.56
|
| Rate for Payer: Humana Commercial |
$9,099.97
|
| Rate for Payer: Humana KY Medicaid |
$3,681.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,719.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,778.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,900.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,211.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,755.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,421.15
|
| Rate for Payer: Ohio Health Group HMO |
$8,029.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,141.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,391.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,318.81
|
| Rate for Payer: PHCS Commercial |
$10,277.62
|
| Rate for Payer: United Healthcare All Payer |
$9,421.15
|
|
|
ARTEGRAFT BOVINE 8MMX15CM
|
Facility
|
IP
|
$8,891.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.94 |
| Max. Negotiated Rate |
$8,536.18 |
| Rate for Payer: Aetna Commercial |
$6,846.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.64
|
| Rate for Payer: Cash Price |
$4,445.92
|
| Rate for Payer: Cigna Commercial |
$7,380.24
|
| Rate for Payer: First Health Commercial |
$8,447.26
|
| Rate for Payer: Humana Commercial |
$7,558.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,291.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,562.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,756.47
|
| Rate for Payer: PHCS Commercial |
$8,536.18
|
| Rate for Payer: United Healthcare All Payer |
$7,824.83
|
|
|
ARTEGRAFT BOVINE 8MMX15CM
|
Facility
|
OP
|
$8,891.85
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
27000052
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.94 |
| Max. Negotiated Rate |
$8,536.18 |
| Rate for Payer: Aetna Commercial |
$6,846.72
|
| Rate for Payer: Anthem Medicaid |
$3,057.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,935.64
|
| Rate for Payer: Cash Price |
$4,445.92
|
| Rate for Payer: Cigna Commercial |
$7,380.24
|
| Rate for Payer: First Health Commercial |
$8,447.26
|
| Rate for Payer: Humana Commercial |
$7,558.07
|
| Rate for Payer: Humana KY Medicaid |
$3,057.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,089.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,291.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,562.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,667.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,119.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,824.83
|
| Rate for Payer: Ohio Health Group HMO |
$6,668.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,778.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,155.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,756.47
|
| Rate for Payer: PHCS Commercial |
$8,536.18
|
| Rate for Payer: United Healthcare All Payer |
$7,824.83
|
|
|
ARTERIAL BLOOD GAS STICK
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
76101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.38
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ARTERIAL BLOOD GAS STICK
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
76101499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$133.38
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ARTERIAL BLOOD GAS STICK RT
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem Medicaid |
$58.81
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$110.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$154.64
|
| Rate for Payer: CareSource Just4Me Medicare |
$149.12
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Humana KY Medicaid |
$58.81
|
| Rate for Payer: Humana Medicare Advantage |
$110.46
|
| Rate for Payer: Kentucky WC Medicaid |
$59.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$59.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ARTERIAL BLOOD GAS STICK RT
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 36600
|
| Hospital Charge Code |
30000004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$164.16 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$137.31
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$141.93
|
| Rate for Payer: First Health Commercial |
$162.45
|
| Rate for Payer: Humana Commercial |
$145.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$140.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$126.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$51.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$150.48
|
| Rate for Payer: Ohio Health Group HMO |
$128.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$34.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$53.01
|
| Rate for Payer: PHCS Commercial |
$164.16
|
| Rate for Payer: United Healthcare All Payer |
$150.48
|
|
|
ARTERIAL CANNUL/CATH FOR SAM(P
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
761P1501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Anthem Medicaid |
$89.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$200.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cigna Commercial |
$155.58
|
| Rate for Payer: Healthspan PPO |
$136.17
|
| Rate for Payer: Humana Medicaid |
$89.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.15
|
| Rate for Payer: Molina Healthcare Passport |
$89.36
|
| Rate for Payer: Multiplan PHCS |
$120.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$140.00
|
| Rate for Payer: UHCCP Medicaid |
$70.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.25
|
|
|
ARTERIAL CANNUL/CATH FOR SAMP
|
Facility
|
IP
|
$2,326.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
76101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$2,233.13 |
| Rate for Payer: Aetna Commercial |
$1,791.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,814.42
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cigna Commercial |
$1,930.73
|
| Rate for Payer: First Health Commercial |
$2,209.87
|
| Rate for Payer: Humana Commercial |
$1,977.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,907.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,716.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,047.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,744.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.12
|
| Rate for Payer: PHCS Commercial |
$2,233.13
|
| Rate for Payer: United Healthcare All Payer |
$2,047.04
|
|
|
ARTERIAL CANNUL/CATH FOR SAMP
|
Professional
|
Both
|
$2,326.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
76101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$2,326.18 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Anthem Medicaid |
$89.36
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,326.18
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cigna Commercial |
$155.58
|
| Rate for Payer: Healthspan PPO |
$136.17
|
| Rate for Payer: Humana Medicaid |
$89.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$139.88
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$91.15
|
| Rate for Payer: Molina Healthcare Passport |
$89.36
|
| Rate for Payer: Multiplan PHCS |
$1,395.71
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,628.33
|
| Rate for Payer: UHCCP Medicaid |
$814.16
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$90.25
|
|
|
ARTERIAL CANNUL/CATH FOR SAMP
|
Facility
|
OP
|
$2,326.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
76101501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$302.40 |
| Max. Negotiated Rate |
$2,233.13 |
| Rate for Payer: Aetna Commercial |
$1,791.16
|
| Rate for Payer: Anthem Medicaid |
$799.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,814.42
|
| Rate for Payer: Cash Price |
$1,163.09
|
| Rate for Payer: Cigna Commercial |
$1,930.73
|
| Rate for Payer: First Health Commercial |
$2,209.87
|
| Rate for Payer: Humana Commercial |
$1,977.25
|
| Rate for Payer: Humana KY Medicaid |
$799.97
|
| Rate for Payer: Kentucky WC Medicaid |
$808.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,907.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,716.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$697.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$816.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,047.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,744.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$465.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$302.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$721.12
|
| Rate for Payer: PHCS Commercial |
$2,233.13
|
| Rate for Payer: United Healthcare All Payer |
$2,047.04
|
|
|
ARTERIAL CANNUL/CATH FOR SAM(T
|
Facility
|
IP
|
$2,126.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
761T1501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$2,041.13 |
| Rate for Payer: Aetna Commercial |
$1,637.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.42
|
| Rate for Payer: Cash Price |
$1,063.09
|
| Rate for Payer: Cigna Commercial |
$1,764.73
|
| Rate for Payer: First Health Commercial |
$2,019.87
|
| Rate for Payer: Humana Commercial |
$1,807.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.12
|
| Rate for Payer: PHCS Commercial |
$2,041.13
|
| Rate for Payer: United Healthcare All Payer |
$1,871.04
|
|
|
ARTERIAL CANNUL/CATH FOR SAM(T
|
Facility
|
OP
|
$2,126.18
|
|
|
Service Code
|
HCPCS 36625
|
| Hospital Charge Code |
761T1501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$2,041.13 |
| Rate for Payer: Aetna Commercial |
$1,637.16
|
| Rate for Payer: Anthem Medicaid |
$731.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.42
|
| Rate for Payer: Cash Price |
$1,063.09
|
| Rate for Payer: Cigna Commercial |
$1,764.73
|
| Rate for Payer: First Health Commercial |
$2,019.87
|
| Rate for Payer: Humana Commercial |
$1,807.25
|
| Rate for Payer: Humana KY Medicaid |
$731.19
|
| Rate for Payer: Kentucky WC Medicaid |
$738.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,569.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,871.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$425.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$659.12
|
| Rate for Payer: PHCS Commercial |
$2,041.13
|
| Rate for Payer: United Healthcare All Payer |
$1,871.04
|
|
|
ARTERIOGRAM OF EXTREMITY
|
Facility
|
IP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000390
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
|
ARTERIOGRAM OF EXTREMITY
|
Facility
|
OP
|
$4,575.00
|
|
|
Service Code
|
HCPCS 75710
|
| Hospital Charge Code |
32000390
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$594.75 |
| Max. Negotiated Rate |
$4,392.00 |
| Rate for Payer: Aetna Commercial |
$3,522.75
|
| Rate for Payer: Anthem Medicaid |
$1,573.34
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$3,797.25
|
| Rate for Payer: First Health Commercial |
$4,346.25
|
| Rate for Payer: Humana Commercial |
$3,888.75
|
| Rate for Payer: Humana KY Medicaid |
$1,573.34
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,376.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,026.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,431.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.25
|
| Rate for Payer: PHCS Commercial |
$4,392.00
|
| Rate for Payer: United Healthcare All Payer |
$4,026.00
|
|
