|
Perc d-e cor stent ather s
|
Facility
|
OP
|
$30,893.00
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
48100085
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,624.10 |
| Max. Negotiated Rate |
$29,657.28 |
| Rate for Payer: Aetna Commercial |
$23,787.61
|
| Rate for Payer: Anthem Medicaid |
$10,624.10
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$16,591.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24,096.54
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$23,228.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$22,398.73
|
| Rate for Payer: Cash Price |
$15,446.50
|
| Rate for Payer: Cash Price |
$15,446.50
|
| Rate for Payer: Cigna Commercial |
$25,641.19
|
| Rate for Payer: First Health Commercial |
$29,348.35
|
| Rate for Payer: Humana Commercial |
$26,259.05
|
| Rate for Payer: Humana KY Medicaid |
$10,624.10
|
| Rate for Payer: Humana Medicare Advantage |
$16,591.65
|
| Rate for Payer: Kentucky WC Medicaid |
$10,732.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25,332.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$22,799.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$19,909.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,837.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$27,185.84
|
| Rate for Payer: Ohio Health Group HMO |
$23,169.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$24,714.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$26,876.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21,316.17
|
| Rate for Payer: PHCS Commercial |
$29,657.28
|
| Rate for Payer: United Healthcare All Payer |
$27,185.84
|
|
|
Perc d-e cor stent ather s
|
Facility
|
IP
|
$27,495.00
|
|
|
Service Code
|
HCPCS C9602
|
| Hospital Charge Code |
76102526
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$8,248.50 |
| Max. Negotiated Rate |
$26,395.20 |
| Rate for Payer: Aetna Commercial |
$21,171.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,446.10
|
| Rate for Payer: Cash Price |
$13,747.50
|
| Rate for Payer: Cigna Commercial |
$22,820.85
|
| Rate for Payer: First Health Commercial |
$26,120.25
|
| Rate for Payer: Humana Commercial |
$23,370.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,545.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,291.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,248.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,195.60
|
| Rate for Payer: Ohio Health Group HMO |
$20,621.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$21,996.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$23,920.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18,971.55
|
| Rate for Payer: PHCS Commercial |
$26,395.20
|
| Rate for Payer: United Healthcare All Payer |
$24,195.60
|
|
|
PERC DE COR STENT SINGLE
|
Facility
|
OP
|
$19,418.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
76102524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$6,677.85 |
| Max. Negotiated Rate |
$18,641.28 |
| Rate for Payer: Aetna Commercial |
$14,951.86
|
| Rate for Payer: Anthem Medicaid |
$6,677.85
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,146.04
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$9,709.00
|
| Rate for Payer: Cash Price |
$9,709.00
|
| Rate for Payer: Cigna Commercial |
$16,116.94
|
| Rate for Payer: First Health Commercial |
$18,447.10
|
| Rate for Payer: Humana Commercial |
$16,505.30
|
| Rate for Payer: Humana KY Medicaid |
$6,677.85
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$6,745.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,922.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,330.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,811.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,087.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,893.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,398.42
|
| Rate for Payer: PHCS Commercial |
$18,641.28
|
| Rate for Payer: United Healthcare All Payer |
$17,087.84
|
|
|
PERC DE COR STENT SINGLE
|
Facility
|
OP
|
$20,760.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,139.36 |
| Max. Negotiated Rate |
$19,929.60 |
| Rate for Payer: Aetna Commercial |
$15,985.20
|
| Rate for Payer: Anthem Medicaid |
$7,139.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$10,478.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,192.80
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$14,669.84
|
| Rate for Payer: CareSource Just4Me Medicare |
$14,145.92
|
| Rate for Payer: Cash Price |
$10,380.00
|
| Rate for Payer: Cash Price |
$10,380.00
|
| Rate for Payer: Cigna Commercial |
$17,230.80
|
| Rate for Payer: First Health Commercial |
$19,722.00
|
| Rate for Payer: Humana Commercial |
$17,646.00
|
| Rate for Payer: Humana KY Medicaid |
$7,139.36
|
| Rate for Payer: Humana Medicare Advantage |
$10,478.46
|
| Rate for Payer: Kentucky WC Medicaid |
$7,212.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,023.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,320.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,574.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,282.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,268.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,061.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,324.40
|
| Rate for Payer: PHCS Commercial |
$19,929.60
|
| Rate for Payer: United Healthcare All Payer |
$18,268.80
|
|
|
PERC DE COR STENT SINGLE
|
Facility
|
IP
|
$20,760.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
48100083
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,228.00 |
| Max. Negotiated Rate |
$19,929.60 |
| Rate for Payer: Aetna Commercial |
$15,985.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,192.80
|
| Rate for Payer: Cash Price |
$10,380.00
|
| Rate for Payer: Cigna Commercial |
$17,230.80
|
| Rate for Payer: First Health Commercial |
$19,722.00
|
| Rate for Payer: Humana Commercial |
$17,646.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,023.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,320.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,228.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,268.80
|
| Rate for Payer: Ohio Health Group HMO |
$15,570.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$16,608.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,061.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,324.40
|
| Rate for Payer: PHCS Commercial |
$19,929.60
|
| Rate for Payer: United Healthcare All Payer |
$18,268.80
|
|
|
PERC DE COR STENT SINGLE
|
Facility
|
IP
|
$19,418.00
|
|
|
Service Code
|
HCPCS C9600
|
| Hospital Charge Code |
76102524
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$5,825.40 |
| Max. Negotiated Rate |
$18,641.28 |
| Rate for Payer: Aetna Commercial |
$14,951.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$15,146.04
|
| Rate for Payer: Cash Price |
$9,709.00
|
| Rate for Payer: Cigna Commercial |
$16,116.94
|
| Rate for Payer: First Health Commercial |
$18,447.10
|
| Rate for Payer: Humana Commercial |
$16,505.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,922.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,330.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,825.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$17,087.84
|
| Rate for Payer: Ohio Health Group HMO |
$14,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,534.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,893.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,398.42
|
| Rate for Payer: PHCS Commercial |
$18,641.28
|
| Rate for Payer: United Healthcare All Payer |
$17,087.84
|
|
|
Perc drug-el cor stent bran
|
Facility
|
IP
|
$15,789.00
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,736.70 |
| Max. Negotiated Rate |
$15,157.44 |
| Rate for Payer: Aetna Commercial |
$12,157.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,315.42
|
| Rate for Payer: Cash Price |
$7,894.50
|
| Rate for Payer: Cigna Commercial |
$13,104.87
|
| Rate for Payer: First Health Commercial |
$14,999.55
|
| Rate for Payer: Humana Commercial |
$13,420.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,946.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,652.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,736.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,894.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,841.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,736.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,894.41
|
| Rate for Payer: PHCS Commercial |
$15,157.44
|
| Rate for Payer: United Healthcare All Payer |
$13,894.32
|
|
|
Perc drug-el cor stent bran
|
Facility
|
IP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
76102525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,215.60 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
Perc drug-el cor stent bran
|
Facility
|
OP
|
$15,789.00
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
48100084
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,736.70 |
| Max. Negotiated Rate |
$15,157.44 |
| Rate for Payer: Aetna Commercial |
$12,157.53
|
| Rate for Payer: Anthem Medicaid |
$5,429.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,315.42
|
| Rate for Payer: Cash Price |
$7,894.50
|
| Rate for Payer: Cigna Commercial |
$13,104.87
|
| Rate for Payer: First Health Commercial |
$14,999.55
|
| Rate for Payer: Humana Commercial |
$13,420.65
|
| Rate for Payer: Humana KY Medicaid |
$5,429.84
|
| Rate for Payer: Kentucky WC Medicaid |
$5,485.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,946.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,652.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,736.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,538.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,894.32
|
| Rate for Payer: Ohio Health Group HMO |
$11,841.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,631.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,736.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,894.41
|
| Rate for Payer: PHCS Commercial |
$15,157.44
|
| Rate for Payer: United Healthcare All Payer |
$13,894.32
|
|
|
Perc drug-el cor stent bran
|
Facility
|
OP
|
$14,052.00
|
|
|
Service Code
|
HCPCS C9601
|
| Hospital Charge Code |
76102525
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,215.60 |
| Max. Negotiated Rate |
$13,489.92 |
| Rate for Payer: Aetna Commercial |
$10,820.04
|
| Rate for Payer: Anthem Medicaid |
$4,832.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,960.56
|
| Rate for Payer: Cash Price |
$7,026.00
|
| Rate for Payer: Cigna Commercial |
$11,663.16
|
| Rate for Payer: First Health Commercial |
$13,349.40
|
| Rate for Payer: Humana Commercial |
$11,944.20
|
| Rate for Payer: Humana KY Medicaid |
$4,832.48
|
| Rate for Payer: Kentucky WC Medicaid |
$4,881.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,522.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,370.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,215.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,929.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,365.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,539.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,241.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,225.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,695.88
|
| Rate for Payer: PHCS Commercial |
$13,489.92
|
| Rate for Payer: United Healthcare All Payer |
$12,365.76
|
|
|
PERCLOSE PROGLIDE
|
Facility
|
OP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem Medicaid |
$700.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Humana KY Medicaid |
$700.59
|
| Rate for Payer: Kentucky WC Medicaid |
$707.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
PERCLOSE PROGLIDE
|
Facility
|
IP
|
$2,037.20
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$611.16 |
| Max. Negotiated Rate |
$1,955.71 |
| Rate for Payer: Aetna Commercial |
$1,568.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,589.02
|
| Rate for Payer: Cash Price |
$1,018.60
|
| Rate for Payer: Cigna Commercial |
$1,690.88
|
| Rate for Payer: First Health Commercial |
$1,935.34
|
| Rate for Payer: Humana Commercial |
$1,731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,629.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,772.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,405.67
|
| Rate for Payer: PHCS Commercial |
$1,955.71
|
| Rate for Payer: United Healthcare All Payer |
$1,792.74
|
|
|
PERCLOSE PROGLIDE SYSTEM
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
PERCLOSE PROGLIDE SYSTEM
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
PERCLOSE PROSTYLE
|
Facility
|
OP
|
$11,317.10
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,395.13 |
| Max. Negotiated Rate |
$10,864.42 |
| Rate for Payer: Aetna Commercial |
$8,714.17
|
| Rate for Payer: Anthem Medicaid |
$3,891.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,827.34
|
| Rate for Payer: Cash Price |
$5,658.55
|
| Rate for Payer: Cigna Commercial |
$9,393.19
|
| Rate for Payer: First Health Commercial |
$10,751.25
|
| Rate for Payer: Humana Commercial |
$9,619.53
|
| Rate for Payer: Humana KY Medicaid |
$3,891.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,931.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,395.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,970.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,959.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,487.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,053.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,845.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,808.80
|
| Rate for Payer: PHCS Commercial |
$10,864.42
|
| Rate for Payer: United Healthcare All Payer |
$9,959.05
|
|
|
PERCLOSE PROSTYLE
|
Facility
|
IP
|
$11,317.10
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27000043
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,395.13 |
| Max. Negotiated Rate |
$10,864.42 |
| Rate for Payer: Aetna Commercial |
$8,714.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,827.34
|
| Rate for Payer: Cash Price |
$5,658.55
|
| Rate for Payer: Cigna Commercial |
$9,393.19
|
| Rate for Payer: First Health Commercial |
$10,751.25
|
| Rate for Payer: Humana Commercial |
$9,619.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,395.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,959.05
|
| Rate for Payer: Ohio Health Group HMO |
$8,487.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,053.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,845.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,808.80
|
| Rate for Payer: PHCS Commercial |
$10,864.42
|
| Rate for Payer: United Healthcare All Payer |
$9,959.05
|
|
|
PERC NEPH NEW ACCESS W/O CATH
|
Professional
|
Both
|
$5,637.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
76102055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$3,382.20 |
| Rate for Payer: Ambetter Exchange |
$247.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.95
|
| Rate for Payer: Anthem Medicaid |
$874.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.77
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$471.97
|
| Rate for Payer: Humana Medicaid |
$874.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.35
|
| Rate for Payer: Molina Healthcare Passport |
$874.85
|
| Rate for Payer: Multiplan PHCS |
$3,382.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.50
|
| Rate for Payer: UHCCP Medicaid |
$240.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.31
|
|
|
PERC NEPH NEW ACCESS W/O CATH
|
Facility
|
IP
|
$5,637.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
76102055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,691.10 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,691.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,889.53
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
PERC NEPH NEW ACCESS W/O CATH
|
Facility
|
OP
|
$5,637.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
76102055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,938.56 |
| Max. Negotiated Rate |
$5,411.52 |
| Rate for Payer: Aetna Commercial |
$4,340.49
|
| Rate for Payer: Anthem Medicaid |
$1,938.56
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,396.86
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cash Price |
$2,818.50
|
| Rate for Payer: Cigna Commercial |
$4,678.71
|
| Rate for Payer: First Health Commercial |
$5,355.15
|
| Rate for Payer: Humana Commercial |
$4,791.45
|
| Rate for Payer: Humana KY Medicaid |
$1,938.56
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,958.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,622.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,160.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,977.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,960.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,227.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,509.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,904.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,889.53
|
| Rate for Payer: PHCS Commercial |
$5,411.52
|
| Rate for Payer: United Healthcare All Payer |
$4,960.56
|
|
|
PERC NEPH NEW ACC W NEPH CATH
|
Professional
|
Both
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$290.23 |
| Max. Negotiated Rate |
$3,517.20 |
| Rate for Payer: Ambetter Exchange |
$317.19
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$290.23
|
| Rate for Payer: Anthem Medicaid |
$1,068.01
|
| Rate for Payer: Buckeye Individual/Medicaid |
$317.19
|
| Rate for Payer: Buckeye Medicare Advantage |
$317.19
|
| Rate for Payer: CareSource Just4Me Medicare |
$380.63
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$599.18
|
| Rate for Payer: Humana Medicaid |
$1,068.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$489.75
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$317.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$317.19
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,089.37
|
| Rate for Payer: Molina Healthcare Passport |
$1,068.01
|
| Rate for Payer: Multiplan PHCS |
$3,517.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$412.35
|
| Rate for Payer: UHCCP Medicaid |
$304.74
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,078.69
|
| Rate for Payer: Wellcare Medicare Advantage |
$317.19
|
|
|
PERC NEPH NEW ACC W NEPH CATH
|
Facility
|
IP
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,758.60 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$4,513.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,572.36
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,865.46
|
| Rate for Payer: First Health Commercial |
$5,568.90
|
| Rate for Payer: Humana Commercial |
$4,982.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,806.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,326.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,758.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,099.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,044.78
|
| Rate for Payer: PHCS Commercial |
$5,627.52
|
| Rate for Payer: United Healthcare All Payer |
$5,158.56
|
|
|
PERC NEPH NEW ACC W NEPH CATH
|
Facility
|
OP
|
$5,862.00
|
|
|
Service Code
|
HCPCS 50695
|
| Hospital Charge Code |
76102056
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,015.94 |
| Max. Negotiated Rate |
$5,627.52 |
| Rate for Payer: Aetna Commercial |
$4,513.74
|
| Rate for Payer: Anthem Medicaid |
$2,015.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,572.36
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,931.00
|
| Rate for Payer: Cigna Commercial |
$4,865.46
|
| Rate for Payer: First Health Commercial |
$5,568.90
|
| Rate for Payer: Humana Commercial |
$4,982.70
|
| Rate for Payer: Humana KY Medicaid |
$2,015.94
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,036.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,806.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,326.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,056.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,158.56
|
| Rate for Payer: Ohio Health Group HMO |
$4,396.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,689.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,099.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,044.78
|
| Rate for Payer: PHCS Commercial |
$5,627.52
|
| Rate for Payer: United Healthcare All Payer |
$5,158.56
|
|
|
PERC NEPH NEW ACC W/O CATH (P
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
761P2055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$228.95 |
| Max. Negotiated Rate |
$892.35 |
| Rate for Payer: Ambetter Exchange |
$247.31
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$228.95
|
| Rate for Payer: Anthem Medicaid |
$874.85
|
| Rate for Payer: Buckeye Individual/Medicaid |
$247.31
|
| Rate for Payer: Buckeye Medicare Advantage |
$247.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$296.77
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cash Price |
$565.00
|
| Rate for Payer: Cigna Commercial |
$471.97
|
| Rate for Payer: Humana Medicaid |
$874.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$385.73
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$247.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$892.35
|
| Rate for Payer: Molina Healthcare Passport |
$874.85
|
| Rate for Payer: Multiplan PHCS |
$678.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$321.50
|
| Rate for Payer: UHCCP Medicaid |
$240.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$883.60
|
| Rate for Payer: Wellcare Medicare Advantage |
$247.31
|
|
|
PERC NEPH NEW ACC W/O CATH (T
|
Facility
|
OP
|
$4,507.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
761T2055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,549.96 |
| Max. Negotiated Rate |
$4,461.49 |
| Rate for Payer: Aetna Commercial |
$3,470.39
|
| Rate for Payer: Anthem Medicaid |
$1,549.96
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$3,186.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,515.46
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,461.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,302.15
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$3,740.81
|
| Rate for Payer: First Health Commercial |
$4,281.65
|
| Rate for Payer: Humana Commercial |
$3,830.95
|
| Rate for Payer: Humana KY Medicaid |
$1,549.96
|
| Rate for Payer: Humana Medicare Advantage |
$3,186.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,565.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,695.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,326.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,581.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,966.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,605.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,921.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.83
|
| Rate for Payer: PHCS Commercial |
$4,326.72
|
| Rate for Payer: United Healthcare All Payer |
$3,966.16
|
|
|
PERC NEPH NEW ACC W/O CATH (T
|
Facility
|
IP
|
$4,507.00
|
|
|
Service Code
|
HCPCS 50694
|
| Hospital Charge Code |
761T2055
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,352.10 |
| Max. Negotiated Rate |
$4,326.72 |
| Rate for Payer: Aetna Commercial |
$3,470.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,515.46
|
| Rate for Payer: Cash Price |
$2,253.50
|
| Rate for Payer: Cigna Commercial |
$3,740.81
|
| Rate for Payer: First Health Commercial |
$4,281.65
|
| Rate for Payer: Humana Commercial |
$3,830.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,695.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,326.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,352.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,966.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,380.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,605.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,921.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,109.83
|
| Rate for Payer: PHCS Commercial |
$4,326.72
|
| Rate for Payer: United Healthcare All Payer |
$3,966.16
|
|
