|
CATHETER THORACIC 32FR RT ANGL
|
Facility
|
OP
|
$457.38
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$439.08 |
| Rate for Payer: Aetna Commercial |
$352.18
|
| Rate for Payer: Anthem Medicaid |
$157.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.76
|
| Rate for Payer: Cash Price |
$228.69
|
| Rate for Payer: Cigna Commercial |
$379.63
|
| Rate for Payer: First Health Commercial |
$434.51
|
| Rate for Payer: Humana Commercial |
$388.77
|
| Rate for Payer: Humana KY Medicaid |
$157.29
|
| Rate for Payer: Kentucky WC Medicaid |
$158.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$160.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.49
|
| Rate for Payer: Ohio Health Group HMO |
$343.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.79
|
| Rate for Payer: PHCS Commercial |
$439.08
|
| Rate for Payer: United Healthcare All Payer |
$402.49
|
|
|
CATHETER THORACIC 32FR RT ANGL
|
Facility
|
IP
|
$457.38
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$439.08 |
| Rate for Payer: Aetna Commercial |
$352.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$356.76
|
| Rate for Payer: Cash Price |
$228.69
|
| Rate for Payer: Cigna Commercial |
$379.63
|
| Rate for Payer: First Health Commercial |
$434.51
|
| Rate for Payer: Humana Commercial |
$388.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$375.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$337.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$137.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$402.49
|
| Rate for Payer: Ohio Health Group HMO |
$343.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$91.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$59.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$141.79
|
| Rate for Payer: PHCS Commercial |
$439.08
|
| Rate for Payer: United Healthcare All Payer |
$402.49
|
|
|
CATH EXT CAROTID UNILATERAL
|
Facility
|
OP
|
$11,224.00
|
|
|
Service Code
|
HCPCS 36227
|
| Hospital Charge Code |
76101450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,459.12 |
| Max. Negotiated Rate |
$10,775.04 |
| Rate for Payer: Aetna Commercial |
$8,642.48
|
| Rate for Payer: Anthem Medicaid |
$3,859.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,754.72
|
| Rate for Payer: Cash Price |
$5,612.00
|
| Rate for Payer: Cigna Commercial |
$9,315.92
|
| Rate for Payer: First Health Commercial |
$10,662.80
|
| Rate for Payer: Humana Commercial |
$9,540.40
|
| Rate for Payer: Humana KY Medicaid |
$3,859.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,899.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,203.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,283.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,367.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,937.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,877.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,418.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,459.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,479.44
|
| Rate for Payer: PHCS Commercial |
$10,775.04
|
| Rate for Payer: United Healthcare All Payer |
$9,877.12
|
|
|
CATH EXT CAROTID UNILATERAL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36227
|
| Hospital Charge Code |
36000041
|
|
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 EXT CAROTID UNILATERAL
|
Facility
|
IP
|
$11,224.00
|
|
|
Service Code
|
HCPCS 36227
|
| Hospital Charge Code |
76101450
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,459.12 |
| Max. Negotiated Rate |
$10,775.04 |
| Rate for Payer: Aetna Commercial |
$8,642.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,754.72
|
| Rate for Payer: Cash Price |
$5,612.00
|
| Rate for Payer: Cigna Commercial |
$9,315.92
|
| Rate for Payer: First Health Commercial |
$10,662.80
|
| Rate for Payer: Humana Commercial |
$9,540.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,203.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,283.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,367.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,877.12
|
| Rate for Payer: Ohio Health Group HMO |
$8,418.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,244.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,459.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,479.44
|
| Rate for Payer: PHCS Commercial |
$10,775.04
|
| Rate for Payer: United Healthcare All Payer |
$9,877.12
|
|
|
CATH EXT CAROTID UNILATERAL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36227
|
| Hospital Charge Code |
36000041
|
|
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 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: Humana KY Medicaid |
$4,336.24
|
| 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 |
$3,782.70
|
| 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 FEM ARTERY SNGL LUMEN 5F
|
Facility
|
OP
|
$802.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem Medicaid |
$275.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Humana KY Medicaid |
$275.98
|
| Rate for Payer: Kentucky WC Medicaid |
$278.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
CATH FEM ARTERY SNGL LUMEN 5F
|
Facility
|
IP
|
$802.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$617.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.95
|
| Rate for Payer: Cash Price |
$401.25
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: First Health Commercial |
$762.38
|
| Rate for Payer: Humana Commercial |
$682.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$658.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$592.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$706.20
|
| Rate for Payer: Ohio Health Group HMO |
$601.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.78
|
| Rate for Payer: PHCS Commercial |
$770.40
|
| Rate for Payer: United Healthcare All Payer |
$706.20
|
|
|
CATHFLO ACTIVASE 2MG VIAL
|
Facility
|
OP
|
$961.11
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.97 |
| Max. Negotiated Rate |
$922.67 |
| Rate for Payer: Aetna Commercial |
$740.05
|
| Rate for Payer: Anthem Medicaid |
$330.53
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$88.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$749.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$124.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.11
|
| Rate for Payer: Cash Price |
$480.56
|
| Rate for Payer: Cash Price |
$480.56
|
| Rate for Payer: Cigna Commercial |
$797.72
|
| Rate for Payer: First Health Commercial |
$913.05
|
| Rate for Payer: Humana Commercial |
$816.94
|
| Rate for Payer: Humana KY Medicaid |
$330.53
|
| Rate for Payer: Humana Medicare Advantage |
$88.97
|
| Rate for Payer: Kentucky WC Medicaid |
$333.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$337.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$845.78
|
| Rate for Payer: Ohio Health Group HMO |
$720.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.94
|
| Rate for Payer: PHCS Commercial |
$922.67
|
| Rate for Payer: United Healthcare All Payer |
$845.78
|
|
|
CATHFLO ACTIVASE 2MG VIAL
|
Facility
|
IP
|
$961.11
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.94 |
| Max. Negotiated Rate |
$922.67 |
| Rate for Payer: Aetna Commercial |
$740.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$749.67
|
| Rate for Payer: Cash Price |
$480.56
|
| Rate for Payer: Cigna Commercial |
$797.72
|
| Rate for Payer: First Health Commercial |
$913.05
|
| Rate for Payer: Humana Commercial |
$816.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$788.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$709.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$288.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$845.78
|
| Rate for Payer: Ohio Health Group HMO |
$720.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$192.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$124.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$297.94
|
| Rate for Payer: PHCS Commercial |
$922.67
|
| Rate for Payer: United Healthcare All Payer |
$845.78
|
|
|
CATHFLO/ALTEPLASE 1MG SOLN
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.12
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
CATHFLO/ALTEPLASE 1MG SOLN
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem Medicaid |
$121.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$88.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$124.56
|
| Rate for Payer: CareSource Just4Me Medicare |
$120.11
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Humana KY Medicaid |
$121.05
|
| Rate for Payer: Humana Medicare Advantage |
$88.97
|
| Rate for Payer: Kentucky WC Medicaid |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$106.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$70.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$45.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$109.12
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
CATH FOLEY 12FR 5CC
|
Facility
|
OP
|
$163.12
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Anthem Medicaid |
$56.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.23
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cigna Commercial |
$135.39
|
| Rate for Payer: First Health Commercial |
$154.96
|
| Rate for Payer: Humana Commercial |
$138.65
|
| Rate for Payer: Humana KY Medicaid |
$56.10
|
| Rate for Payer: Kentucky WC Medicaid |
$56.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$57.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.55
|
| Rate for Payer: Ohio Health Group HMO |
$122.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.57
|
| Rate for Payer: PHCS Commercial |
$156.60
|
| Rate for Payer: United Healthcare All Payer |
$143.55
|
|
|
CATH FOLEY 12FR 5CC
|
Facility
|
IP
|
$163.12
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$156.60 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$127.23
|
| Rate for Payer: Cash Price |
$81.56
|
| Rate for Payer: Cigna Commercial |
$135.39
|
| Rate for Payer: First Health Commercial |
$154.96
|
| Rate for Payer: Humana Commercial |
$138.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$133.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$120.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$48.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$143.55
|
| Rate for Payer: Ohio Health Group HMO |
$122.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$32.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$50.57
|
| Rate for Payer: PHCS Commercial |
$156.60
|
| Rate for Payer: United Healthcare All Payer |
$143.55
|
|
|
CATH GUIDING HOCKY STICK 8FR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH GUIDING HOCKY STICK 8FR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH GUIDING RENAL 8FR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH GUIDING RENAL 8FR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH GUIDING RENAL MULTI 8FR
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
CATH GUIDING RENAL MULTI 8FR
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
CATH GUIDING STRAIGHT 8FR
|
Facility
|
IP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
CATH GUIDING STRAIGHT 8FR
|
Facility
|
OP
|
$1,787.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Aetna Commercial |
$1,376.38
|
| Rate for Payer: Anthem Medicaid |
$614.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.25
|
| Rate for Payer: Cash Price |
$893.75
|
| Rate for Payer: Cigna Commercial |
$1,483.62
|
| Rate for Payer: First Health Commercial |
$1,698.12
|
| Rate for Payer: Humana Commercial |
$1,519.38
|
| Rate for Payer: Humana KY Medicaid |
$614.72
|
| Rate for Payer: Kentucky WC Medicaid |
$620.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.12
|
| Rate for Payer: PHCS Commercial |
$1,716.00
|
| Rate for Payer: United Healthcare All Payer |
$1,573.00
|
|
|
CATH HICKMAN DIALYSIS 13.5FR
|
Facility
|
IP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
CATH HICKMAN DIALYSIS 13.5FR
|
Facility
|
OP
|
$1,927.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.58 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Aetna Commercial |
$1,484.18
|
| Rate for Payer: Anthem Medicaid |
$662.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.45
|
| Rate for Payer: Cash Price |
$963.75
|
| Rate for Payer: Cigna Commercial |
$1,599.82
|
| Rate for Payer: First Health Commercial |
$1,831.12
|
| Rate for Payer: Humana Commercial |
$1,638.38
|
| Rate for Payer: Humana KY Medicaid |
$662.87
|
| Rate for Payer: Kentucky WC Medicaid |
$669.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$676.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,696.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.52
|
| Rate for Payer: PHCS Commercial |
$1,850.40
|
| Rate for Payer: United Healthcare All Payer |
$1,696.20
|
|
|
CATH IN 20G*1 1/4 ACUVANCE
|
Facility
|
OP
|
$31.27
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$30.02 |
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Anthem Medicaid |
$10.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.39
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cigna Commercial |
$25.95
|
| Rate for Payer: First Health Commercial |
$29.71
|
| Rate for Payer: Humana Commercial |
$26.58
|
| Rate for Payer: Humana KY Medicaid |
$10.75
|
| Rate for Payer: Kentucky WC Medicaid |
$10.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.52
|
| Rate for Payer: Ohio Health Group HMO |
$23.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.69
|
| Rate for Payer: PHCS Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Payer |
$27.52
|
|
