|
CATH EMBOL OTW 3FR*6MM LEMATRE
|
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 EMBOL OTW 3FR*6MM LEMATRE
|
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 EMB SYNTEL 5FR*80CM LF
|
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 EMB SYNTEL 5FR*80CM LF
|
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
|
|
|
CATH EQUISTREAM 24CM
|
Facility
|
IP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
CATH EQUISTREAM 24CM
|
Facility
|
OP
|
$3,512.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.62 |
| Max. Negotiated Rate |
$3,372.00 |
| Rate for Payer: Aetna Commercial |
$2,704.62
|
| Rate for Payer: Anthem Medicaid |
$1,207.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,739.75
|
| Rate for Payer: Cash Price |
$1,756.25
|
| Rate for Payer: Cigna Commercial |
$2,915.38
|
| Rate for Payer: First Health Commercial |
$3,336.88
|
| Rate for Payer: Humana Commercial |
$2,985.62
|
| Rate for Payer: Humana KY Medicaid |
$1,207.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,220.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,880.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,592.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,232.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,091.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,634.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$702.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$456.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,088.88
|
| Rate for Payer: PHCS Commercial |
$3,372.00
|
| Rate for Payer: United Healthcare All Payer |
$3,091.00
|
|
|
CATHETER 8F 50CM
|
Facility
|
IP
|
$13,118.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$12,593.76 |
| Rate for Payer: Aetna Commercial |
$10,101.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.43
|
| Rate for Payer: Cash Price |
$6,559.25
|
| Rate for Payer: Cigna Commercial |
$10,888.36
|
| Rate for Payer: First Health Commercial |
$12,462.58
|
| Rate for Payer: Humana Commercial |
$11,150.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,838.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,623.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,705.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,066.74
|
| Rate for Payer: PHCS Commercial |
$12,593.76
|
| Rate for Payer: United Healthcare All Payer |
$11,544.28
|
|
|
CATHETER 8F 50CM
|
Facility
|
OP
|
$13,118.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,705.40 |
| Max. Negotiated Rate |
$12,593.76 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,232.43
|
| Rate for Payer: Cash Price |
$6,559.25
|
| Rate for Payer: Cigna Commercial |
$10,888.36
|
| Rate for Payer: First Health Commercial |
$12,462.58
|
| Rate for Payer: Humana Commercial |
$11,150.72
|
| Rate for Payer: Humana KY Medicaid |
$4,511.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,557.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,757.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,681.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,935.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,601.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,544.28
|
| Rate for Payer: Ohio Health Group HMO |
$9,838.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,623.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,705.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,066.74
|
| Rate for Payer: PHCS Commercial |
$12,593.76
|
| Rate for Payer: United Healthcare All Payer |
$11,544.28
|
| Rate for Payer: Aetna Commercial |
$10,101.24
|
| Rate for Payer: Anthem Medicaid |
$4,511.45
|
|
|
CATHETER C-CAE-19.0-83
|
Facility
|
IP
|
$1,117.55
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$1,072.85 |
| Rate for Payer: Aetna Commercial |
$860.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$871.69
|
| Rate for Payer: Cash Price |
$558.77
|
| Rate for Payer: Cigna Commercial |
$927.57
|
| Rate for Payer: First Health Commercial |
$1,061.67
|
| Rate for Payer: Humana Commercial |
$949.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$916.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$983.44
|
| Rate for Payer: Ohio Health Group HMO |
$838.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.44
|
| Rate for Payer: PHCS Commercial |
$1,072.85
|
| Rate for Payer: United Healthcare All Payer |
$983.44
|
|
|
CATHETER C-CAE-19.0-83
|
Facility
|
OP
|
$1,117.55
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$1,072.85 |
| Rate for Payer: Aetna Commercial |
$860.51
|
| Rate for Payer: Anthem Medicaid |
$384.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$871.69
|
| Rate for Payer: Cash Price |
$558.77
|
| Rate for Payer: Cigna Commercial |
$927.57
|
| Rate for Payer: First Health Commercial |
$1,061.67
|
| Rate for Payer: Humana Commercial |
$949.92
|
| Rate for Payer: Humana KY Medicaid |
$384.33
|
| Rate for Payer: Kentucky WC Medicaid |
$388.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$916.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$335.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$983.44
|
| Rate for Payer: Ohio Health Group HMO |
$838.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.44
|
| Rate for Payer: PHCS Commercial |
$1,072.85
|
| Rate for Payer: United Healthcare All Payer |
$983.44
|
|
|
CATHETER CCOMBO/SVO2 8FR
|
Facility
|
OP
|
$3,608.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.10 |
| Max. Negotiated Rate |
$3,464.13 |
| Rate for Payer: Aetna Commercial |
$2,778.52
|
| Rate for Payer: Anthem Medicaid |
$1,240.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,814.61
|
| Rate for Payer: Cash Price |
$1,804.23
|
| Rate for Payer: Cigna Commercial |
$2,995.03
|
| Rate for Payer: First Health Commercial |
$3,428.05
|
| Rate for Payer: Humana Commercial |
$3,067.20
|
| Rate for Payer: Humana KY Medicaid |
$1,240.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,253.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,958.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,663.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,082.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,265.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,175.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,706.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$721.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,118.63
|
| Rate for Payer: PHCS Commercial |
$3,464.13
|
| Rate for Payer: United Healthcare All Payer |
$3,175.45
|
|
|
CATHETER CCOMBO/SVO2 8FR
|
Facility
|
IP
|
$3,608.47
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.10 |
| Max. Negotiated Rate |
$3,464.13 |
| Rate for Payer: Aetna Commercial |
$2,778.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,814.61
|
| Rate for Payer: Cash Price |
$1,804.23
|
| Rate for Payer: Cigna Commercial |
$2,995.03
|
| Rate for Payer: First Health Commercial |
$3,428.05
|
| Rate for Payer: Humana Commercial |
$3,067.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,958.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,663.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,082.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,175.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,706.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$721.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,118.63
|
| Rate for Payer: PHCS Commercial |
$3,464.13
|
| Rate for Payer: United Healthcare All Payer |
$3,175.45
|
|
|
CATHETER COMMAND 6250V-MB2
|
Facility
|
IP
|
$2,092.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.52
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
CATHETER COMMAND 6250V-MB2
|
Facility
|
OP
|
$2,092.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem Medicaid |
$719.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Humana KY Medicaid |
$719.44
|
| Rate for Payer: Kentucky WC Medicaid |
$726.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.52
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
CATHETER DIALYSIS 12.5 CM PC
|
Facility
|
IP
|
$1,764.76
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.42 |
| Max. Negotiated Rate |
$1,694.17 |
| Rate for Payer: Aetna Commercial |
$1,358.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,376.51
|
| Rate for Payer: Cash Price |
$882.38
|
| Rate for Payer: Cigna Commercial |
$1,464.75
|
| Rate for Payer: First Health Commercial |
$1,676.52
|
| Rate for Payer: Humana Commercial |
$1,500.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,447.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,302.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,552.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,323.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.08
|
| Rate for Payer: PHCS Commercial |
$1,694.17
|
| Rate for Payer: United Healthcare All Payer |
$1,552.99
|
|
|
CATHETER DIALYSIS 12.5 CM PC
|
Facility
|
OP
|
$1,764.76
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.42 |
| Max. Negotiated Rate |
$1,694.17 |
| Rate for Payer: Aetna Commercial |
$1,358.87
|
| Rate for Payer: Anthem Medicaid |
$606.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,376.51
|
| Rate for Payer: Cash Price |
$882.38
|
| Rate for Payer: Cigna Commercial |
$1,464.75
|
| Rate for Payer: First Health Commercial |
$1,676.52
|
| Rate for Payer: Humana Commercial |
$1,500.05
|
| Rate for Payer: Humana KY Medicaid |
$606.90
|
| Rate for Payer: Kentucky WC Medicaid |
$613.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,447.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,302.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,552.99
|
| Rate for Payer: Ohio Health Group HMO |
$1,323.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$547.08
|
| Rate for Payer: PHCS Commercial |
$1,694.17
|
| Rate for Payer: United Healthcare All Payer |
$1,552.99
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
76102223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$1,248.96 |
| Rate for Payer: Aetna Commercial |
$1,001.77
|
| Rate for Payer: Anthem Medicaid |
$447.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.78
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,079.83
|
| Rate for Payer: First Health Commercial |
$1,235.95
|
| Rate for Payer: Humana Commercial |
$1,105.85
|
| Rate for Payer: Humana KY Medicaid |
$447.41
|
| Rate for Payer: Kentucky WC Medicaid |
$451.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.88
|
| Rate for Payer: Ohio Health Group HMO |
$975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.31
|
| Rate for Payer: PHCS Commercial |
$1,248.96
|
| Rate for Payer: United Healthcare All Payer |
$1,144.88
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
32001016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.66 |
| Max. Negotiated Rate |
$1,230.72 |
| Rate for Payer: Aetna Commercial |
$987.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$999.96
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cigna Commercial |
$1,064.06
|
| Rate for Payer: First Health Commercial |
$1,217.90
|
| Rate for Payer: Humana Commercial |
$1,089.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,051.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$946.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,128.16
|
| Rate for Payer: Ohio Health Group HMO |
$961.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.42
|
| Rate for Payer: PHCS Commercial |
$1,230.72
|
| Rate for Payer: United Healthcare All Payer |
$1,128.16
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
76102223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$1,248.96 |
| Rate for Payer: Aetna Commercial |
$1,001.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.78
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$1,079.83
|
| Rate for Payer: First Health Commercial |
$1,235.95
|
| Rate for Payer: Humana Commercial |
$1,105.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$960.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.88
|
| Rate for Payer: Ohio Health Group HMO |
$975.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.31
|
| Rate for Payer: PHCS Commercial |
$1,248.96
|
| Rate for Payer: United Healthcare All Payer |
$1,144.88
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
32001016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.66 |
| Max. Negotiated Rate |
$1,230.72 |
| Rate for Payer: Aetna Commercial |
$987.14
|
| Rate for Payer: Anthem Medicaid |
$440.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$999.96
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cigna Commercial |
$1,064.06
|
| Rate for Payer: First Health Commercial |
$1,217.90
|
| Rate for Payer: Humana Commercial |
$1,089.70
|
| Rate for Payer: Humana KY Medicaid |
$440.88
|
| Rate for Payer: Kentucky WC Medicaid |
$445.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,051.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$946.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$384.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$449.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,128.16
|
| Rate for Payer: Ohio Health Group HMO |
$961.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$256.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$166.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$397.42
|
| Rate for Payer: PHCS Commercial |
$1,230.72
|
| Rate for Payer: United Healthcare All Payer |
$1,128.16
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
76102223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$1,301.00 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,301.00
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cash Price |
$650.50
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$780.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.70
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
|
|
CATHETER FOR HYSTEROGRAPHY
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
32001016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$1,282.00 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,282.00
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cash Price |
$641.00
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$769.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$897.40
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
|
|
CATHETER FOR HYSTEROGRAPHY(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
320P1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
|
|
CATHETER FOR HYSTEROGRAPHY(P
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
761P2223
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$735.00 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$28.73
|
| Rate for Payer: Anthem Medicaid |
$43.05
|
| Rate for Payer: Buckeye Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$217.18
|
| Rate for Payer: Healthspan PPO |
$179.24
|
| Rate for Payer: Humana Medicaid |
$43.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$74.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$43.91
|
| Rate for Payer: Molina Healthcare Passport |
$43.05
|
| Rate for Payer: Multiplan PHCS |
$441.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$514.50
|
| Rate for Payer: UHCCP Medicaid |
$30.17
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$43.48
|
|
|
CATHETER FOR HYSTEROGRAPHY(T
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
HCPCS 58340
|
| Hospital Charge Code |
320T1016
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$543.36 |
| Rate for Payer: Aetna Commercial |
$435.82
|
| Rate for Payer: Anthem Medicaid |
$194.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$441.48
|
| Rate for Payer: Cash Price |
$283.00
|
| Rate for Payer: Cigna Commercial |
$469.78
|
| Rate for Payer: First Health Commercial |
$537.70
|
| Rate for Payer: Humana Commercial |
$481.10
|
| Rate for Payer: Humana KY Medicaid |
$194.65
|
| Rate for Payer: Kentucky WC Medicaid |
$196.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$464.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$417.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$169.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$198.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$498.08
|
| Rate for Payer: Ohio Health Group HMO |
$424.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$113.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$73.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$175.46
|
| Rate for Payer: PHCS Commercial |
$543.36
|
| Rate for Payer: United Healthcare All Payer |
$498.08
|
|
