|
SEGMENT TM CLR FOR 9-16MM 30MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMENT TM CLR FOR 9-16MM 35MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMENT TM CLR FOR 9-16MM 35MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/F PROV 35MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/F PROV 35MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/F PROV 45MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/F PROV 45MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/M PROV 80MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/M PROV 80MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/M PROV 90MM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEGMNTAL FEM/TIB M/M PROV 90MM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
76101439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.00 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,045.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,208.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
76101439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,395.00 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,720.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,045.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,208.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Professional
|
Both
|
$4,650.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
76101439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.05 |
| Max. Negotiated Rate |
$2,790.00 |
| Rate for Payer: Aetna Commercial |
$420.64
|
| Rate for Payer: Ambetter Exchange |
$199.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.05
|
| Rate for Payer: Anthem Medicaid |
$211.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$199.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$199.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$239.46
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$385.06
|
| Rate for Payer: Healthspan PPO |
$1,773.13
|
| Rate for Payer: Humana Medicaid |
$211.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$324.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$199.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.55
|
| Rate for Payer: Molina Healthcare Passport |
$211.32
|
| Rate for Payer: Multiplan PHCS |
$2,790.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.42
|
| Rate for Payer: UHCCP Medicaid |
$174.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$199.55
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
48100011
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,204.28
|
| Rate for Payer: Anthem Medicaid |
$537.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.92
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,298.12
|
| Rate for Payer: First Health Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial |
$1,329.40
|
| Rate for Payer: Humana KY Medicaid |
$537.86
|
| Rate for Payer: Kentucky WC Medicaid |
$543.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,360.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.16
|
| Rate for Payer: PHCS Commercial |
$1,501.44
|
| Rate for Payer: United Healthcare All Payer |
$1,376.32
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
48100011
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$469.20 |
| Max. Negotiated Rate |
$1,501.44 |
| Rate for Payer: Aetna Commercial |
$1,204.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,219.92
|
| Rate for Payer: Cash Price |
$782.00
|
| Rate for Payer: Cigna Commercial |
$1,298.12
|
| Rate for Payer: First Health Commercial |
$1,485.80
|
| Rate for Payer: Humana Commercial |
$1,329.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,282.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,376.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,251.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,360.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.16
|
| Rate for Payer: PHCS Commercial |
$1,501.44
|
| Rate for Payer: United Healthcare All Payer |
$1,376.32
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
761P1439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.05 |
| Max. Negotiated Rate |
$1,773.13 |
| Rate for Payer: Aetna Commercial |
$420.64
|
| Rate for Payer: Ambetter Exchange |
$199.55
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$166.05
|
| Rate for Payer: Anthem Medicaid |
$211.32
|
| Rate for Payer: Buckeye Individual/Medicaid |
$199.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$199.55
|
| Rate for Payer: CareSource Just4Me Medicare |
$239.46
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$385.06
|
| Rate for Payer: Healthspan PPO |
$1,773.13
|
| Rate for Payer: Humana Medicaid |
$211.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$324.29
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$199.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$199.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$215.55
|
| Rate for Payer: Molina Healthcare Passport |
$211.32
|
| Rate for Payer: Multiplan PHCS |
$999.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$259.42
|
| Rate for Payer: UHCCP Medicaid |
$174.35
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$213.43
|
| Rate for Payer: Wellcare Medicare Advantage |
$199.55
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Facility
|
OP
|
$2,985.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
761T1439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.50 |
| Max. Negotiated Rate |
$2,865.60 |
| Rate for Payer: Aetna Commercial |
$2,298.45
|
| Rate for Payer: Anthem Medicaid |
$1,026.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,328.30
|
| Rate for Payer: Cash Price |
$1,492.50
|
| Rate for Payer: Cigna Commercial |
$2,477.55
|
| Rate for Payer: First Health Commercial |
$2,835.75
|
| Rate for Payer: Humana Commercial |
$2,537.25
|
| Rate for Payer: Humana KY Medicaid |
$1,026.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,036.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,447.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,202.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$895.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,047.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,626.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,238.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,596.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.65
|
| Rate for Payer: PHCS Commercial |
$2,865.60
|
| Rate for Payer: United Healthcare All Payer |
$2,626.80
|
|
|
SEL CATH ART EA 1ST THOR BRACH
|
Facility
|
IP
|
$2,985.00
|
|
|
Service Code
|
HCPCS 36215
|
| Hospital Charge Code |
761T1439
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$895.50 |
| Max. Negotiated Rate |
$2,865.60 |
| Rate for Payer: Aetna Commercial |
$2,298.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,328.30
|
| Rate for Payer: Cash Price |
$1,492.50
|
| Rate for Payer: Cigna Commercial |
$2,477.55
|
| Rate for Payer: First Health Commercial |
$2,835.75
|
| Rate for Payer: Humana Commercial |
$2,537.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,447.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,202.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$895.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,626.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,238.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,388.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,596.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,059.65
|
| Rate for Payer: PHCS Commercial |
$2,865.60
|
| Rate for Payer: United Healthcare All Payer |
$2,626.80
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Facility
|
IP
|
$2,995.26
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
761T1440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$898.58 |
| Max. Negotiated Rate |
$2,875.45 |
| Rate for Payer: Aetna Commercial |
$2,306.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,336.30
|
| Rate for Payer: Cash Price |
$1,497.63
|
| Rate for Payer: Cigna Commercial |
$2,486.07
|
| Rate for Payer: First Health Commercial |
$2,845.50
|
| Rate for Payer: Humana Commercial |
$2,545.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,456.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,210.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,635.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,246.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,396.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,066.73
|
| Rate for Payer: PHCS Commercial |
$2,875.45
|
| Rate for Payer: United Healthcare All Payer |
$2,635.83
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Facility
|
OP
|
$2,995.26
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
761T1440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$898.58 |
| Max. Negotiated Rate |
$2,875.45 |
| Rate for Payer: Aetna Commercial |
$2,306.35
|
| Rate for Payer: Anthem Medicaid |
$1,030.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,336.30
|
| Rate for Payer: Cash Price |
$1,497.63
|
| Rate for Payer: Cigna Commercial |
$2,486.07
|
| Rate for Payer: First Health Commercial |
$2,845.50
|
| Rate for Payer: Humana Commercial |
$2,545.97
|
| Rate for Payer: Humana KY Medicaid |
$1,030.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,456.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,210.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,635.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,246.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,396.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,605.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,066.73
|
| Rate for Payer: PHCS Commercial |
$2,875.45
|
| Rate for Payer: United Healthcare All Payer |
$2,635.83
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
48100012
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$456.00 |
| Max. Negotiated Rate |
$1,459.20 |
| Rate for Payer: Aetna Commercial |
$1,170.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,185.60
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cigna Commercial |
$1,261.60
|
| Rate for Payer: First Health Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial |
$1,292.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,121.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,337.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,048.80
|
| Rate for Payer: PHCS Commercial |
$1,459.20
|
| Rate for Payer: United Healthcare All Payer |
$1,337.60
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Professional
|
Both
|
$4,798.26
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
76101440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$2,878.96 |
| Rate for Payer: Aetna Commercial |
$474.44
|
| Rate for Payer: Ambetter Exchange |
$255.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$177.02
|
| Rate for Payer: Anthem Medicaid |
$249.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$255.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$306.91
|
| Rate for Payer: Cash Price |
$2,399.13
|
| Rate for Payer: Cash Price |
$2,399.13
|
| Rate for Payer: Cigna Commercial |
$432.36
|
| Rate for Payer: Healthspan PPO |
$1,939.12
|
| Rate for Payer: Humana Medicaid |
$249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$366.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$255.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.73
|
| Rate for Payer: Molina Healthcare Passport |
$249.74
|
| Rate for Payer: Multiplan PHCS |
$2,878.96
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.49
|
| Rate for Payer: UHCCP Medicaid |
$185.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$255.76
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
761P1440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$1,939.12 |
| Rate for Payer: Aetna Commercial |
$474.44
|
| Rate for Payer: Ambetter Exchange |
$255.76
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$177.02
|
| Rate for Payer: Anthem Medicaid |
$249.74
|
| Rate for Payer: Buckeye Individual/Medicaid |
$255.76
|
| Rate for Payer: Buckeye Medicare Advantage |
$255.76
|
| Rate for Payer: CareSource Just4Me Medicare |
$306.91
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cash Price |
$901.50
|
| Rate for Payer: Cigna Commercial |
$432.36
|
| Rate for Payer: Healthspan PPO |
$1,939.12
|
| Rate for Payer: Humana Medicaid |
$249.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$366.89
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$255.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$255.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$254.73
|
| Rate for Payer: Molina Healthcare Passport |
$249.74
|
| Rate for Payer: Multiplan PHCS |
$1,081.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$332.49
|
| Rate for Payer: UHCCP Medicaid |
$185.87
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$252.24
|
| Rate for Payer: Wellcare Medicare Advantage |
$255.76
|
|
|
SEL CATHART INI 2ND THOR BRACH
|
Facility
|
IP
|
$4,798.26
|
|
|
Service Code
|
HCPCS 36216
|
| Hospital Charge Code |
76101440
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,439.48 |
| Max. Negotiated Rate |
$4,606.33 |
| Rate for Payer: Aetna Commercial |
$3,694.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.64
|
| Rate for Payer: Cash Price |
$2,399.13
|
| Rate for Payer: Cigna Commercial |
$3,982.56
|
| Rate for Payer: First Health Commercial |
$4,558.35
|
| Rate for Payer: Humana Commercial |
$4,078.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,934.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,541.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,222.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,174.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.80
|
| Rate for Payer: PHCS Commercial |
$4,606.33
|
| Rate for Payer: United Healthcare All Payer |
$4,222.47
|
|
