|
CATH CAV DRN KIT AK-01600 CVD
|
Facility
|
IP
|
$1,775.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$1,704.72 |
| Rate for Payer: Aetna Commercial |
$1,367.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,385.08
|
| Rate for Payer: Cash Price |
$887.88
|
| Rate for Payer: Cigna Commercial |
$1,473.87
|
| Rate for Payer: First Health Commercial |
$1,686.96
|
| Rate for Payer: Humana Commercial |
$1,509.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,456.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,310.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.48
|
| Rate for Payer: PHCS Commercial |
$1,704.72
|
| Rate for Payer: United Healthcare All Payer |
$1,562.66
|
|
|
CATH CAV DRN KIT AK-01600 CVD
|
Facility
|
OP
|
$1,775.75
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$1,704.72 |
| Rate for Payer: Aetna Commercial |
$1,367.33
|
| Rate for Payer: Anthem Medicaid |
$610.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,385.08
|
| Rate for Payer: Cash Price |
$887.88
|
| Rate for Payer: Cigna Commercial |
$1,473.87
|
| Rate for Payer: First Health Commercial |
$1,686.96
|
| Rate for Payer: Humana Commercial |
$1,509.39
|
| Rate for Payer: Humana KY Medicaid |
$610.68
|
| Rate for Payer: Kentucky WC Medicaid |
$616.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,456.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,310.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.48
|
| Rate for Payer: PHCS Commercial |
$1,704.72
|
| Rate for Payer: United Healthcare All Payer |
$1,562.66
|
|
|
CATH CLOSURE 6FR*100CM
|
Facility
|
IP
|
$4,737.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.88 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Aetna Commercial |
$3,647.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
| Rate for Payer: Cash Price |
$2,368.75
|
| Rate for Payer: Cigna Commercial |
$3,932.12
|
| Rate for Payer: First Health Commercial |
$4,500.62
|
| Rate for Payer: Humana Commercial |
$4,026.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
| Rate for Payer: PHCS Commercial |
$4,548.00
|
| Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
|
CATH CLOSURE 6FR*100CM
|
Facility
|
OP
|
$4,737.50
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.88 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Aetna Commercial |
$3,647.88
|
| Rate for Payer: Anthem Medicaid |
$1,629.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
| Rate for Payer: Cash Price |
$2,368.75
|
| Rate for Payer: Cigna Commercial |
$3,932.12
|
| Rate for Payer: First Health Commercial |
$4,500.62
|
| Rate for Payer: Humana Commercial |
$4,026.88
|
| Rate for Payer: Humana KY Medicaid |
$1,629.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,645.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,661.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
| Rate for Payer: PHCS Commercial |
$4,548.00
|
| Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761P1445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.24 |
| Max. Negotiated Rate |
$2,000.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.24
|
| Rate for Payer: Anthem Medicaid |
$255.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cigna Commercial |
$590.71
|
| Rate for Payer: Healthspan PPO |
$1,861.09
|
| Rate for Payer: Humana Medicaid |
$255.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.54
|
| Rate for Payer: Molina Healthcare Passport |
$255.43
|
| Rate for Payer: Multiplan PHCS |
$1,200.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,400.00
|
| Rate for Payer: UHCCP Medicaid |
$194.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.98
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
OP
|
$9,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761T1445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,274.65 |
| Max. Negotiated Rate |
$9,412.80 |
| Rate for Payer: Aetna Commercial |
$7,549.85
|
| Rate for Payer: Anthem Medicaid |
$3,371.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,647.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cigna Commercial |
$8,138.15
|
| Rate for Payer: First Health Commercial |
$9,314.75
|
| Rate for Payer: Humana Commercial |
$8,334.25
|
| Rate for Payer: Humana KY Medicaid |
$3,371.94
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,040.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,236.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,439.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,628.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,039.55
|
| Rate for Payer: PHCS Commercial |
$9,412.80
|
| Rate for Payer: United Healthcare All Payer |
$8,628.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$13,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,794.65 |
| Max. Negotiated Rate |
$13,252.80 |
| Rate for Payer: Aetna Commercial |
$10,629.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,767.90
|
| Rate for Payer: Cash Price |
$6,902.50
|
| Rate for Payer: Cigna Commercial |
$11,458.15
|
| Rate for Payer: First Health Commercial |
$13,114.75
|
| Rate for Payer: Humana Commercial |
$11,734.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,320.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,188.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,141.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,761.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,794.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,279.55
|
| Rate for Payer: PHCS Commercial |
$13,252.80
|
| Rate for Payer: United Healthcare All Payer |
$12,148.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
48100017
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
48100017
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
OP
|
$11,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,534.65 |
| Max. Negotiated Rate |
$11,332.80 |
| Rate for Payer: Aetna Commercial |
$9,089.85
|
| Rate for Payer: Anthem Medicaid |
$4,059.74
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,207.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cigna Commercial |
$9,798.15
|
| Rate for Payer: First Health Commercial |
$11,214.75
|
| Rate for Payer: Humana Commercial |
$10,034.25
|
| Rate for Payer: Humana KY Medicaid |
$4,059.74
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,101.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,680.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,712.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,141.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,388.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,853.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,659.55
|
| Rate for Payer: PHCS Commercial |
$11,332.80
|
| Rate for Payer: United Healthcare All Payer |
$10,388.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$11,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,534.65 |
| Max. Negotiated Rate |
$11,332.80 |
| Rate for Payer: Aetna Commercial |
$9,089.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,207.90
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cigna Commercial |
$9,798.15
|
| Rate for Payer: First Health Commercial |
$11,214.75
|
| Rate for Payer: Humana Commercial |
$10,034.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,680.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,712.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,541.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,388.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,853.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,361.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,659.55
|
| Rate for Payer: PHCS Commercial |
$11,332.80
|
| Rate for Payer: United Healthcare All Payer |
$10,388.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$9,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761T1446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,274.65 |
| Max. Negotiated Rate |
$9,412.80 |
| Rate for Payer: Aetna Commercial |
$7,549.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,647.90
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cigna Commercial |
$8,138.15
|
| Rate for Payer: First Health Commercial |
$9,314.75
|
| Rate for Payer: Humana Commercial |
$8,334.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,040.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,236.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,628.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,039.55
|
| Rate for Payer: PHCS Commercial |
$9,412.80
|
| Rate for Payer: United Healthcare All Payer |
$8,628.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Professional
|
Both
|
$13,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.24 |
| Max. Negotiated Rate |
$13,805.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.24
|
| Rate for Payer: Anthem Medicaid |
$255.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$13,805.00
|
| Rate for Payer: Cash Price |
$6,902.50
|
| Rate for Payer: Cash Price |
$6,902.50
|
| Rate for Payer: Cigna Commercial |
$590.71
|
| Rate for Payer: Healthspan PPO |
$1,861.09
|
| Rate for Payer: Humana Medicaid |
$255.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.54
|
| Rate for Payer: Molina Healthcare Passport |
$255.43
|
| Rate for Payer: Multiplan PHCS |
$8,283.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9,663.50
|
| Rate for Payer: UHCCP Medicaid |
$194.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.98
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
OP
|
$13,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,794.65 |
| Max. Negotiated Rate |
$13,252.80 |
| Rate for Payer: Aetna Commercial |
$10,629.85
|
| Rate for Payer: Anthem Medicaid |
$4,747.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,767.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,902.50
|
| Rate for Payer: Cash Price |
$6,902.50
|
| Rate for Payer: Cigna Commercial |
$11,458.15
|
| Rate for Payer: First Health Commercial |
$13,114.75
|
| Rate for Payer: Humana Commercial |
$11,734.25
|
| Rate for Payer: Humana KY Medicaid |
$4,747.54
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,795.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,320.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,188.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,842.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,148.40
|
| Rate for Payer: Ohio Health Group HMO |
$10,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,761.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,794.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,279.55
|
| Rate for Payer: PHCS Commercial |
$13,252.80
|
| Rate for Payer: United Healthcare All Payer |
$12,148.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
OP
|
$9,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761T1446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,274.65 |
| Max. Negotiated Rate |
$9,412.80 |
| Rate for Payer: Aetna Commercial |
$7,549.85
|
| Rate for Payer: Anthem Medicaid |
$3,371.94
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,647.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cigna Commercial |
$8,138.15
|
| Rate for Payer: First Health Commercial |
$9,314.75
|
| Rate for Payer: Humana Commercial |
$8,334.25
|
| Rate for Payer: Humana KY Medicaid |
$3,371.94
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,406.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,040.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,236.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,439.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,628.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,039.55
|
| Rate for Payer: PHCS Commercial |
$9,412.80
|
| Rate for Payer: United Healthcare All Payer |
$8,628.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Professional
|
Both
|
$11,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
76101445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.24 |
| Max. Negotiated Rate |
$11,805.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.24
|
| Rate for Payer: Anthem Medicaid |
$255.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,805.00
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cash Price |
$5,902.50
|
| Rate for Payer: Cigna Commercial |
$590.71
|
| Rate for Payer: Healthspan PPO |
$1,861.09
|
| Rate for Payer: Humana Medicaid |
$255.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.54
|
| Rate for Payer: Molina Healthcare Passport |
$255.43
|
| Rate for Payer: Multiplan PHCS |
$7,083.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,263.50
|
| Rate for Payer: UHCCP Medicaid |
$194.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.98
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$9,805.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761T1445
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,274.65 |
| Max. Negotiated Rate |
$9,412.80 |
| Rate for Payer: Aetna Commercial |
$7,549.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,647.90
|
| Rate for Payer: Cash Price |
$4,902.50
|
| Rate for Payer: Cigna Commercial |
$8,138.15
|
| Rate for Payer: First Health Commercial |
$9,314.75
|
| Rate for Payer: Humana Commercial |
$8,334.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,040.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,236.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,941.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,628.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,353.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,961.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,274.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,039.55
|
| Rate for Payer: PHCS Commercial |
$9,412.80
|
| Rate for Payer: United Healthcare All Payer |
$8,628.40
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
761P1446
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$185.24 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$185.24
|
| Rate for Payer: Anthem Medicaid |
$255.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$4,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cigna Commercial |
$590.71
|
| Rate for Payer: Healthspan PPO |
$1,861.09
|
| Rate for Payer: Humana Medicaid |
$255.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$400.74
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$260.54
|
| Rate for Payer: Molina Healthcare Passport |
$255.43
|
| Rate for Payer: Multiplan PHCS |
$2,400.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,800.00
|
| Rate for Payer: UHCCP Medicaid |
$194.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$257.98
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH COM CAR N ART UNIL WEXTCR
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36223
|
| Hospital Charge Code |
36000039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,782.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH COM CAROTI OR INOM ARTUNI
|
Facility
|
OP
|
$8,608.50
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
761T1444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,119.10 |
| Max. Negotiated Rate |
$8,264.16 |
| Rate for Payer: Aetna Commercial |
$6,628.54
|
| Rate for Payer: Anthem Medicaid |
$2,960.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,714.63
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$4,304.25
|
| Rate for Payer: Cash Price |
$4,304.25
|
| Rate for Payer: Cigna Commercial |
$7,145.06
|
| Rate for Payer: First Health Commercial |
$8,178.08
|
| Rate for Payer: Humana Commercial |
$7,317.22
|
| Rate for Payer: Humana KY Medicaid |
$2,960.46
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,990.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,058.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,353.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,019.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,575.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,456.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.64
|
| Rate for Payer: PHCS Commercial |
$8,264.16
|
| Rate for Payer: United Healthcare All Payer |
$7,575.48
|
|
|
CATH COM CAROTI OR INOM ARTUNI
|
Facility
|
IP
|
$8,608.50
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
761T1444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,119.10 |
| Max. Negotiated Rate |
$8,264.16 |
| Rate for Payer: Aetna Commercial |
$6,628.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,714.63
|
| Rate for Payer: Cash Price |
$4,304.25
|
| Rate for Payer: Cigna Commercial |
$7,145.06
|
| Rate for Payer: First Health Commercial |
$8,178.08
|
| Rate for Payer: Humana Commercial |
$7,317.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,058.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,353.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,582.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,575.48
|
| Rate for Payer: Ohio Health Group HMO |
$6,456.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,721.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,119.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,668.64
|
| Rate for Payer: PHCS Commercial |
$8,264.16
|
| Rate for Payer: United Healthcare All Payer |
$7,575.48
|
|
|
CATH COM CAROTI OR INOM ARTUNI
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
36000038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH COM CAROTI OR INOM ARTUNI
|
Facility
|
IP
|
$11,608.50
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
76101444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,509.10 |
| Max. Negotiated Rate |
$11,144.16 |
| Rate for Payer: Aetna Commercial |
$8,938.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,054.63
|
| Rate for Payer: Cash Price |
$5,804.25
|
| Rate for Payer: Cigna Commercial |
$9,635.06
|
| Rate for Payer: First Health Commercial |
$11,028.08
|
| Rate for Payer: Humana Commercial |
$9,867.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,518.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,567.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,482.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,215.48
|
| Rate for Payer: Ohio Health Group HMO |
$8,706.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,321.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,598.64
|
| Rate for Payer: PHCS Commercial |
$11,144.16
|
| Rate for Payer: United Healthcare All Payer |
$10,215.48
|
|
|
CATH COM CAROTI OR INOM ARTUNI
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
761P1444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.33 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.33
|
| Rate for Payer: Anthem Medicaid |
$236.23
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,000.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cash Price |
$1,500.00
|
| Rate for Payer: Cigna Commercial |
$546.34
|
| Rate for Payer: Healthspan PPO |
$1,707.72
|
| Rate for Payer: Humana Medicaid |
$236.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$370.63
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$240.95
|
| Rate for Payer: Molina Healthcare Passport |
$236.23
|
| Rate for Payer: Multiplan PHCS |
$1,800.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,100.00
|
| Rate for Payer: UHCCP Medicaid |
$179.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.59
|
|
