|
CATH COM CAROTI OR INOM ARTUNI
|
Professional
|
Both
|
$11,608.50
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
76101444
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.33 |
| Max. Negotiated Rate |
$11,608.50 |
| 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 |
$11,608.50
|
| Rate for Payer: Cash Price |
$5,804.25
|
| Rate for Payer: Cash Price |
$5,804.25
|
| 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 |
$6,965.10
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,125.95
|
| Rate for Payer: UHCCP Medicaid |
$179.90
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$238.59
|
|
|
CATH COM CAROTI OR INOM ARTUNI
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
48100016
|
|
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 |
$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
|
$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 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
|
$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 Medicaid |
$3,992.16
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,054.63
|
| 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 |
$5,804.25
|
| 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: Humana KY Medicaid |
$3,992.16
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,032.79
|
| 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 |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,072.26
|
| 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
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36222
|
| Hospital Charge Code |
48100016
|
|
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 COR ART W/INJ & S&I
|
Facility
|
IP
|
$11,972.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
76102478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,556.36 |
| Max. Negotiated Rate |
$11,493.12 |
| Rate for Payer: Aetna Commercial |
$9,218.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,338.16
|
| Rate for Payer: Cash Price |
$5,986.00
|
| Rate for Payer: Cigna Commercial |
$9,936.76
|
| Rate for Payer: First Health Commercial |
$11,373.40
|
| Rate for Payer: Humana Commercial |
$10,176.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,817.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,835.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,591.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,535.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,979.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,711.32
|
| Rate for Payer: PHCS Commercial |
$11,493.12
|
| Rate for Payer: United Healthcare All Payer |
$10,535.36
|
|
|
CATH COR ART W/INJ & S&I
|
Facility
|
OP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
48100065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem Medicaid |
$3,955.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Humana KY Medicaid |
$3,955.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,995.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,034.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
CATH COR ART W/INJ & S&I
|
Facility
|
OP
|
$11,972.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
76102478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,556.36 |
| Max. Negotiated Rate |
$11,493.12 |
| Rate for Payer: Aetna Commercial |
$9,218.44
|
| Rate for Payer: Anthem Medicaid |
$4,117.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,338.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$5,986.00
|
| Rate for Payer: Cash Price |
$5,986.00
|
| Rate for Payer: Cigna Commercial |
$9,936.76
|
| Rate for Payer: First Health Commercial |
$11,373.40
|
| Rate for Payer: Humana Commercial |
$10,176.20
|
| Rate for Payer: Humana KY Medicaid |
$4,117.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$4,159.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,817.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,835.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,199.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,535.36
|
| Rate for Payer: Ohio Health Group HMO |
$8,979.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,711.32
|
| Rate for Payer: PHCS Commercial |
$11,493.12
|
| Rate for Payer: United Healthcare All Payer |
$10,535.36
|
|
|
CATH COR ART W/INJ & S&I
|
Professional
|
Both
|
$11,972.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
76102478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.37 |
| Max. Negotiated Rate |
$11,972.00 |
| Rate for Payer: Aetna Commercial |
$1,370.99
|
| Rate for Payer: Anthem Medicaid |
$763.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,972.00
|
| Rate for Payer: Cash Price |
$5,986.00
|
| Rate for Payer: Cash Price |
$5,986.00
|
| Rate for Payer: Cigna Commercial |
$1,501.73
|
| Rate for Payer: Healthspan PPO |
$1,019.65
|
| Rate for Payer: Humana Medicaid |
$763.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$778.68
|
| Rate for Payer: Molina Healthcare Passport |
$763.41
|
| Rate for Payer: Multiplan PHCS |
$7,183.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$8,380.40
|
| Rate for Payer: UHCCP Medicaid |
$4,190.20
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$771.04
|
|
|
CATH COR ART W/INJ & S&I
|
Facility
|
IP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
48100065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
CATH COR ART W/INJ & S&I(P
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
761P2478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$1,501.73 |
| Rate for Payer: Aetna Commercial |
$1,370.99
|
| Rate for Payer: Anthem Medicaid |
$763.41
|
| Rate for Payer: Buckeye Medicare Advantage |
$470.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$1,501.73
|
| Rate for Payer: Healthspan PPO |
$1,019.65
|
| Rate for Payer: Humana Medicaid |
$763.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.37
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$778.68
|
| Rate for Payer: Molina Healthcare Passport |
$763.41
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$329.00
|
| Rate for Payer: UHCCP Medicaid |
$164.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$771.04
|
|
|
CATH COR ART W/INJ & S&I(T
|
Facility
|
OP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
761T2478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem Medicaid |
$3,955.54
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,817.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,944.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,804.10
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Humana KY Medicaid |
$3,955.54
|
| Rate for Payer: Humana Medicare Advantage |
$2,817.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,995.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,381.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,034.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
CATH COR ART W/INJ & S&I(T
|
Facility
|
IP
|
$11,502.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
761T2478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,495.26 |
| Max. Negotiated Rate |
$11,041.92 |
| Rate for Payer: Aetna Commercial |
$8,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,971.56
|
| Rate for Payer: Cash Price |
$5,751.00
|
| Rate for Payer: Cigna Commercial |
$9,546.66
|
| Rate for Payer: First Health Commercial |
$10,926.90
|
| Rate for Payer: Humana Commercial |
$9,776.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,431.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,488.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,450.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,121.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,626.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,300.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,495.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,565.62
|
| Rate for Payer: PHCS Commercial |
$11,041.92
|
| Rate for Payer: United Healthcare All Payer |
$10,121.76
|
|
|
CATH CPS AIM UNV SLITTABL 65CM
|
Facility
|
IP
|
$2,015.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
CATH CPS AIM UNV SLITTABL 65CM
|
Facility
|
OP
|
$2,015.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.95 |
| Max. Negotiated Rate |
$1,934.40 |
| Rate for Payer: Aetna Commercial |
$1,551.55
|
| Rate for Payer: Anthem Medicaid |
$692.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,571.70
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cigna Commercial |
$1,672.45
|
| Rate for Payer: First Health Commercial |
$1,914.25
|
| Rate for Payer: Humana Commercial |
$1,712.75
|
| Rate for Payer: Humana KY Medicaid |
$692.96
|
| Rate for Payer: Kentucky WC Medicaid |
$700.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,652.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$604.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$706.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,773.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,511.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$624.65
|
| Rate for Payer: PHCS Commercial |
$1,934.40
|
| Rate for Payer: United Healthcare All Payer |
$1,773.20
|
|
|
CATH CPS DIRECT UNIV 135CM
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CATH CPS DIRECT UNIV 135CM
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.50 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Aetna Commercial |
$1,578.50
|
| Rate for Payer: Anthem Medicaid |
$705.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.00
|
| Rate for Payer: Cash Price |
$1,025.00
|
| Rate for Payer: Cigna Commercial |
$1,701.50
|
| Rate for Payer: First Health Commercial |
$1,947.50
|
| Rate for Payer: Humana Commercial |
$1,742.50
|
| Rate for Payer: Humana KY Medicaid |
$705.00
|
| Rate for Payer: Kentucky WC Medicaid |
$712.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.50
|
| Rate for Payer: PHCS Commercial |
$1,968.00
|
| Rate for Payer: United Healthcare All Payer |
$1,804.00
|
|
|
CATH DIALYSIS 52CM
|
Facility
|
OP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem Medicaid |
$626.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Humana KY Medicaid |
$626.76
|
| Rate for Payer: Kentucky WC Medicaid |
$633.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
CATH DIALYSIS 52CM
|
Facility
|
IP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
CATH EMBLOTW 4FR*10MM LEMAITRE
|
Facility
|
IP
|
$1,766.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.64 |
| Max. Negotiated Rate |
$1,695.84 |
| Rate for Payer: Aetna Commercial |
$1,360.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.87
|
| Rate for Payer: Cash Price |
$883.25
|
| Rate for Payer: Cigna Commercial |
$1,466.20
|
| Rate for Payer: First Health Commercial |
$1,678.18
|
| Rate for Payer: Humana Commercial |
$1,501.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.62
|
| Rate for Payer: PHCS Commercial |
$1,695.84
|
| Rate for Payer: United Healthcare All Payer |
$1,554.52
|
|
|
CATH EMBLOTW 4FR*10MM LEMAITRE
|
Facility
|
OP
|
$1,766.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.64 |
| Max. Negotiated Rate |
$1,695.84 |
| Rate for Payer: Aetna Commercial |
$1,360.20
|
| Rate for Payer: Anthem Medicaid |
$607.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.87
|
| Rate for Payer: Cash Price |
$883.25
|
| Rate for Payer: Cigna Commercial |
$1,466.20
|
| Rate for Payer: First Health Commercial |
$1,678.18
|
| Rate for Payer: Humana Commercial |
$1,501.52
|
| Rate for Payer: Humana KY Medicaid |
$607.50
|
| Rate for Payer: Kentucky WC Medicaid |
$613.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.62
|
| Rate for Payer: PHCS Commercial |
$1,695.84
|
| Rate for Payer: United Healthcare All Payer |
$1,554.52
|
|
|
CATH EMBLOTW 5FR*12MM LEMAITRE
|
Facility
|
IP
|
$1,766.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.64 |
| Max. Negotiated Rate |
$1,695.84 |
| Rate for Payer: Aetna Commercial |
$1,360.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.87
|
| Rate for Payer: Cash Price |
$883.25
|
| Rate for Payer: Cigna Commercial |
$1,466.20
|
| Rate for Payer: First Health Commercial |
$1,678.18
|
| Rate for Payer: Humana Commercial |
$1,501.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.62
|
| Rate for Payer: PHCS Commercial |
$1,695.84
|
| Rate for Payer: United Healthcare All Payer |
$1,554.52
|
|
|
CATH EMBLOTW 5FR*12MM LEMAITRE
|
Facility
|
OP
|
$1,766.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.64 |
| Max. Negotiated Rate |
$1,695.84 |
| Rate for Payer: Aetna Commercial |
$1,360.20
|
| Rate for Payer: Anthem Medicaid |
$607.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,377.87
|
| Rate for Payer: Cash Price |
$883.25
|
| Rate for Payer: Cigna Commercial |
$1,466.20
|
| Rate for Payer: First Health Commercial |
$1,678.18
|
| Rate for Payer: Humana Commercial |
$1,501.52
|
| Rate for Payer: Humana KY Medicaid |
$607.50
|
| Rate for Payer: Kentucky WC Medicaid |
$613.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,324.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.62
|
| Rate for Payer: PHCS Commercial |
$1,695.84
|
| Rate for Payer: United Healthcare All Payer |
$1,554.52
|
|
|
CATH EMBOLECTOMY 4FR 80CM
|
Facility
|
IP
|
$1,906.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
|
CATH EMBOLECTOMY 4FR 80CM
|
Facility
|
OP
|
$1,906.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.84 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Aetna Commercial |
$1,468.00
|
| Rate for Payer: Anthem Medicaid |
$655.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,487.07
|
| Rate for Payer: Cash Price |
$953.25
|
| Rate for Payer: Cigna Commercial |
$1,582.40
|
| Rate for Payer: First Health Commercial |
$1,811.18
|
| Rate for Payer: Humana Commercial |
$1,620.52
|
| Rate for Payer: Humana KY Medicaid |
$655.65
|
| Rate for Payer: Kentucky WC Medicaid |
$662.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,563.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,407.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$668.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,677.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,429.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$381.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$591.02
|
| Rate for Payer: PHCS Commercial |
$1,830.24
|
| Rate for Payer: United Healthcare All Payer |
$1,677.72
|
|
