|
SEL CATH PLCMNT 3RD ORDER(P
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 36013
|
| Hospital Charge Code |
761P1434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$94.53 |
| Max. Negotiated Rate |
$1,241.37 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: Ambetter Exchange |
$117.67
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$94.53
|
| Rate for Payer: Anthem Medicaid |
$138.07
|
| Rate for Payer: Buckeye Individual/Medicaid |
$117.67
|
| Rate for Payer: Buckeye Medicare Advantage |
$117.67
|
| Rate for Payer: CareSource Just4Me Medicare |
$141.20
|
| Rate for Payer: Cash Price |
$623.00
|
| Rate for Payer: Cash Price |
$623.00
|
| Rate for Payer: Cigna Commercial |
$206.62
|
| Rate for Payer: Healthspan PPO |
$1,241.37
|
| Rate for Payer: Humana Medicaid |
$138.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$171.46
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$117.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$117.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$140.83
|
| Rate for Payer: Molina Healthcare Passport |
$138.07
|
| Rate for Payer: Multiplan PHCS |
$747.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$152.97
|
| Rate for Payer: UHCCP Medicaid |
$99.26
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$139.45
|
| Rate for Payer: Wellcare Medicare Advantage |
$117.67
|
|
|
SEL CATH PLCMNT 3RD ORDER(T
|
Facility
|
OP
|
$1,633.00
|
|
|
Service Code
|
HCPCS 36013
|
| Hospital Charge Code |
761T1434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$1,567.68 |
| Rate for Payer: Aetna Commercial |
$1,257.41
|
| Rate for Payer: Anthem Medicaid |
$561.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,273.74
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cigna Commercial |
$1,355.39
|
| Rate for Payer: First Health Commercial |
$1,551.35
|
| Rate for Payer: Humana Commercial |
$1,388.05
|
| Rate for Payer: Humana KY Medicaid |
$561.59
|
| Rate for Payer: Kentucky WC Medicaid |
$567.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,339.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,205.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$572.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,437.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,126.77
|
| Rate for Payer: PHCS Commercial |
$1,567.68
|
| Rate for Payer: United Healthcare All Payer |
$1,437.04
|
|
|
SEL CATH PLCMNT 3RD ORDER(T
|
Facility
|
IP
|
$1,633.00
|
|
|
Service Code
|
HCPCS 36013
|
| Hospital Charge Code |
761T1434
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$1,567.68 |
| Rate for Payer: Aetna Commercial |
$1,257.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,273.74
|
| Rate for Payer: Cash Price |
$816.50
|
| Rate for Payer: Cigna Commercial |
$1,355.39
|
| Rate for Payer: First Health Commercial |
$1,551.35
|
| Rate for Payer: Humana Commercial |
$1,388.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,339.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,205.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$489.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,437.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,224.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,420.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,126.77
|
| Rate for Payer: PHCS Commercial |
$1,567.68
|
| Rate for Payer: United Healthcare All Payer |
$1,437.04
|
|
|
SELCT II ATTAIN CATH 6248V-130
|
Facility
|
IP
|
$1,911.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$573.54 |
| Max. Negotiated Rate |
$1,835.33 |
| Rate for Payer: Aetna Commercial |
$1,472.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.20
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cigna Commercial |
$1,586.79
|
| Rate for Payer: First Health Commercial |
$1,816.21
|
| Rate for Payer: Humana Commercial |
$1,625.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.14
|
| Rate for Payer: PHCS Commercial |
$1,835.33
|
| Rate for Payer: United Healthcare All Payer |
$1,682.38
|
|
|
SELCT II ATTAIN CATH 6248V-130
|
Facility
|
OP
|
$1,911.80
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$573.54 |
| Max. Negotiated Rate |
$1,835.33 |
| Rate for Payer: Aetna Commercial |
$1,472.09
|
| Rate for Payer: Anthem Medicaid |
$657.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.20
|
| Rate for Payer: Cash Price |
$955.90
|
| Rate for Payer: Cigna Commercial |
$1,586.79
|
| Rate for Payer: First Health Commercial |
$1,816.21
|
| Rate for Payer: Humana Commercial |
$1,625.03
|
| Rate for Payer: Humana KY Medicaid |
$657.47
|
| Rate for Payer: Kentucky WC Medicaid |
$664.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,663.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.14
|
| Rate for Payer: PHCS Commercial |
$1,835.33
|
| Rate for Payer: United Healthcare All Payer |
$1,682.38
|
|
|
SELCT II ATTN CATH 6248V-130P
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
SELCT II ATTN CATH 6248V-130P
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
SELCT PRI PORHUM STEM 11.5*125
|
Facility
|
IP
|
$24,027.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,208.25 |
| Max. Negotiated Rate |
$23,066.40 |
| Rate for Payer: Aetna Commercial |
$18,501.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,741.45
|
| Rate for Payer: Cash Price |
$12,013.75
|
| Rate for Payer: Cigna Commercial |
$19,942.83
|
| Rate for Payer: First Health Commercial |
$22,826.12
|
| Rate for Payer: Humana Commercial |
$20,423.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,702.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,732.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,208.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,144.20
|
| Rate for Payer: Ohio Health Group HMO |
$18,020.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,903.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,578.97
|
| Rate for Payer: PHCS Commercial |
$23,066.40
|
| Rate for Payer: United Healthcare All Payer |
$21,144.20
|
|
|
SELCT PRI PORHUM STEM 11.5*125
|
Facility
|
OP
|
$24,027.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,208.25 |
| Max. Negotiated Rate |
$23,066.40 |
| Rate for Payer: Aetna Commercial |
$18,501.17
|
| Rate for Payer: Anthem Medicaid |
$8,263.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,741.45
|
| Rate for Payer: Cash Price |
$12,013.75
|
| Rate for Payer: Cigna Commercial |
$19,942.83
|
| Rate for Payer: First Health Commercial |
$22,826.12
|
| Rate for Payer: Humana Commercial |
$20,423.38
|
| Rate for Payer: Humana KY Medicaid |
$8,263.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,347.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,702.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,732.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,208.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,428.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,144.20
|
| Rate for Payer: Ohio Health Group HMO |
$18,020.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,903.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,578.97
|
| Rate for Payer: PHCS Commercial |
$23,066.40
|
| Rate for Payer: United Healthcare All Payer |
$21,144.20
|
|
|
SELCT PRI POR HUM STEM 8.5*125
|
Facility
|
OP
|
$24,027.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,208.25 |
| Max. Negotiated Rate |
$23,066.40 |
| Rate for Payer: Aetna Commercial |
$18,501.17
|
| Rate for Payer: Anthem Medicaid |
$8,263.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,741.45
|
| Rate for Payer: Cash Price |
$12,013.75
|
| Rate for Payer: Cigna Commercial |
$19,942.83
|
| Rate for Payer: First Health Commercial |
$22,826.12
|
| Rate for Payer: Humana Commercial |
$20,423.38
|
| Rate for Payer: Humana KY Medicaid |
$8,263.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,347.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,702.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,732.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,208.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,428.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,144.20
|
| Rate for Payer: Ohio Health Group HMO |
$18,020.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,903.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,578.97
|
| Rate for Payer: PHCS Commercial |
$23,066.40
|
| Rate for Payer: United Healthcare All Payer |
$21,144.20
|
|
|
SELCT PRI POR HUM STEM 8.5*125
|
Facility
|
IP
|
$24,027.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,208.25 |
| Max. Negotiated Rate |
$23,066.40 |
| Rate for Payer: Aetna Commercial |
$18,501.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,741.45
|
| Rate for Payer: Cash Price |
$12,013.75
|
| Rate for Payer: Cigna Commercial |
$19,942.83
|
| Rate for Payer: First Health Commercial |
$22,826.12
|
| Rate for Payer: Humana Commercial |
$20,423.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,702.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,732.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,208.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,144.20
|
| Rate for Payer: Ohio Health Group HMO |
$18,020.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$19,222.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20,903.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$16,578.97
|
| Rate for Payer: PHCS Commercial |
$23,066.40
|
| Rate for Payer: United Healthcare All Payer |
$21,144.20
|
|
|
SELECT COCR HUM STEM 14.5*125
|
Facility
|
IP
|
$19,159.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,747.79 |
| Max. Negotiated Rate |
$18,392.93 |
| Rate for Payer: Aetna Commercial |
$14,752.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,944.25
|
| Rate for Payer: Cash Price |
$9,579.65
|
| Rate for Payer: Cigna Commercial |
$15,902.22
|
| Rate for Payer: First Health Commercial |
$18,201.33
|
| Rate for Payer: Humana Commercial |
$16,285.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,139.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,747.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,860.18
|
| Rate for Payer: Ohio Health Group HMO |
$14,369.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,327.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,668.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,219.92
|
| Rate for Payer: PHCS Commercial |
$18,392.93
|
| Rate for Payer: United Healthcare All Payer |
$16,860.18
|
|
|
SELECT COCR HUM STEM 14.5*125
|
Facility
|
OP
|
$19,159.30
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,747.79 |
| Max. Negotiated Rate |
$18,392.93 |
| Rate for Payer: Aetna Commercial |
$14,752.66
|
| Rate for Payer: Anthem Medicaid |
$6,588.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,944.25
|
| Rate for Payer: Cash Price |
$9,579.65
|
| Rate for Payer: Cigna Commercial |
$15,902.22
|
| Rate for Payer: First Health Commercial |
$18,201.33
|
| Rate for Payer: Humana Commercial |
$16,285.41
|
| Rate for Payer: Humana KY Medicaid |
$6,588.88
|
| Rate for Payer: Kentucky WC Medicaid |
$6,655.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,710.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$14,139.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,747.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,721.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,860.18
|
| Rate for Payer: Ohio Health Group HMO |
$14,369.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,327.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,668.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,219.92
|
| Rate for Payer: PHCS Commercial |
$18,392.93
|
| Rate for Payer: United Healthcare All Payer |
$16,860.18
|
|
|
SELECT II ATTN CATH 6248V-130L
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
SELECT II ATTN CATH 6248V-130L
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
SELECTIVE CATHETER PLACEMENT, SUBCLAVIAN OR INNOMINATE ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED
|
Facility
|
OP
|
$4,071.52
|
|
|
Service Code
|
CPT 36225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,908.23 |
| Max. Negotiated Rate |
$4,071.52 |
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,908.23
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,071.52
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,926.11
|
| Rate for Payer: Humana Medicare Advantage |
$2,908.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,489.88
|
|
|
SELECTIVE CATHETER PLACEMNT
|
Facility
|
OP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36014
|
| Hospital Charge Code |
76101435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,069.50 |
| Max. Negotiated Rate |
$3,422.40 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem Medicaid |
$1,226.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Humana KY Medicaid |
$1,226.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,238.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,069.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,250.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.85
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
SELECTIVE CATHETER PLACEMNT
|
Professional
|
Both
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36014
|
| Hospital Charge Code |
76101435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$2,139.00 |
| Rate for Payer: Aetna Commercial |
$270.56
|
| Rate for Payer: Ambetter Exchange |
$142.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.62
|
| Rate for Payer: Anthem Medicaid |
$156.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$142.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$142.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.51
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$246.79
|
| Rate for Payer: Healthspan PPO |
$1,294.21
|
| Rate for Payer: Humana Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$197.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$142.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.46
|
| Rate for Payer: Molina Healthcare Passport |
$156.33
|
| Rate for Payer: Multiplan PHCS |
$2,139.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.72
|
| Rate for Payer: UHCCP Medicaid |
$122.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$142.09
|
|
|
SELECTIVE CATHETER PLACEMNT
|
Facility
|
IP
|
$3,565.00
|
|
|
Service Code
|
HCPCS 36014
|
| Hospital Charge Code |
76101435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,069.50 |
| Max. Negotiated Rate |
$3,422.40 |
| Rate for Payer: Aetna Commercial |
$2,745.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,780.70
|
| Rate for Payer: Cash Price |
$1,782.50
|
| Rate for Payer: Cigna Commercial |
$2,958.95
|
| Rate for Payer: First Health Commercial |
$3,386.75
|
| Rate for Payer: Humana Commercial |
$3,030.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,923.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,630.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,069.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,137.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,673.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,101.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,459.85
|
| Rate for Payer: PHCS Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Payer |
$3,137.20
|
|
|
SELECTIVE CATHETER PLACEMNT(P
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 36014
|
| Hospital Charge Code |
761P1435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$1,294.21 |
| Rate for Payer: Aetna Commercial |
$270.56
|
| Rate for Payer: Ambetter Exchange |
$142.09
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$116.62
|
| Rate for Payer: Anthem Medicaid |
$156.33
|
| Rate for Payer: Buckeye Individual/Medicaid |
$142.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$142.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$170.51
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cash Price |
$750.00
|
| Rate for Payer: Cigna Commercial |
$246.79
|
| Rate for Payer: Healthspan PPO |
$1,294.21
|
| Rate for Payer: Humana Medicaid |
$156.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$197.00
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$142.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$142.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$159.46
|
| Rate for Payer: Molina Healthcare Passport |
$156.33
|
| Rate for Payer: Multiplan PHCS |
$900.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$184.72
|
| Rate for Payer: UHCCP Medicaid |
$122.45
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$157.89
|
| Rate for Payer: Wellcare Medicare Advantage |
$142.09
|
|
|
SELECTIVE CATHETER PLACEMNT(T
|
Facility
|
OP
|
$2,065.00
|
|
|
Service Code
|
HCPCS 36014
|
| Hospital Charge Code |
761T1435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.50 |
| Max. Negotiated Rate |
$1,982.40 |
| Rate for Payer: Aetna Commercial |
$1,590.05
|
| Rate for Payer: Anthem Medicaid |
$710.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,610.70
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: Cigna Commercial |
$1,713.95
|
| Rate for Payer: First Health Commercial |
$1,961.75
|
| Rate for Payer: Humana Commercial |
$1,755.25
|
| Rate for Payer: Humana KY Medicaid |
$710.15
|
| Rate for Payer: Kentucky WC Medicaid |
$717.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,693.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,523.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,817.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,548.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,796.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,424.85
|
| Rate for Payer: PHCS Commercial |
$1,982.40
|
| Rate for Payer: United Healthcare All Payer |
$1,817.20
|
|
|
SELECTIVE CATHETER PLACEMNT(T
|
Facility
|
IP
|
$2,065.00
|
|
|
Service Code
|
HCPCS 36014
|
| Hospital Charge Code |
761T1435
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$619.50 |
| Max. Negotiated Rate |
$1,982.40 |
| Rate for Payer: Aetna Commercial |
$1,590.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,610.70
|
| Rate for Payer: Cash Price |
$1,032.50
|
| Rate for Payer: Cigna Commercial |
$1,713.95
|
| Rate for Payer: First Health Commercial |
$1,961.75
|
| Rate for Payer: Humana Commercial |
$1,755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,693.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,523.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,817.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,548.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,796.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,424.85
|
| Rate for Payer: PHCS Commercial |
$1,982.40
|
| Rate for Payer: United Healthcare All Payer |
$1,817.20
|
|
|
SELECT LONG POR HUM STEM 7*200
|
Facility
|
IP
|
$25,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,732.50 |
| Max. Negotiated Rate |
$24,744.00 |
| Rate for Payer: Aetna Commercial |
$19,846.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,104.50
|
| Rate for Payer: Cash Price |
$12,887.50
|
| Rate for Payer: Cigna Commercial |
$21,393.25
|
| Rate for Payer: First Health Commercial |
$24,486.25
|
| Rate for Payer: Humana Commercial |
$21,908.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,135.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,021.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,732.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,682.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,424.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,784.75
|
| Rate for Payer: PHCS Commercial |
$24,744.00
|
| Rate for Payer: United Healthcare All Payer |
$22,682.00
|
|
|
SELECT LONG POR HUM STEM 7*200
|
Facility
|
OP
|
$25,775.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,732.50 |
| Max. Negotiated Rate |
$24,744.00 |
| Rate for Payer: Aetna Commercial |
$19,846.75
|
| Rate for Payer: Anthem Medicaid |
$8,864.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$20,104.50
|
| Rate for Payer: Cash Price |
$12,887.50
|
| Rate for Payer: Cigna Commercial |
$21,393.25
|
| Rate for Payer: First Health Commercial |
$24,486.25
|
| Rate for Payer: Humana Commercial |
$21,908.75
|
| Rate for Payer: Humana KY Medicaid |
$8,864.02
|
| Rate for Payer: Kentucky WC Medicaid |
$8,954.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$21,135.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$19,021.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,732.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,041.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$22,682.00
|
| Rate for Payer: Ohio Health Group HMO |
$19,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$20,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$22,424.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$17,784.75
|
| Rate for Payer: PHCS Commercial |
$24,744.00
|
| Rate for Payer: United Healthcare All Payer |
$22,682.00
|
|
|
SELECT PRI POR HUM STEM 10*125
|
Facility
|
IP
|
$7,916.55
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.97 |
| Max. Negotiated Rate |
$7,599.89 |
| Rate for Payer: Aetna Commercial |
$6,095.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,174.91
|
| Rate for Payer: Cash Price |
$3,958.28
|
| Rate for Payer: Cigna Commercial |
$6,570.74
|
| Rate for Payer: First Health Commercial |
$7,520.72
|
| Rate for Payer: Humana Commercial |
$6,729.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.56
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.42
|
| Rate for Payer: PHCS Commercial |
$7,599.89
|
| Rate for Payer: United Healthcare All Payer |
$6,966.56
|
|
