|
CATH IN 20G*1 1/4 ACUVANCE
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CATH IN 24G*5/8 ACUVANCE
|
Facility
|
IP
|
$31.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Aetna Commercial |
$24.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.80
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: First Health Commercial |
$30.21
|
| Rate for Payer: Humana Commercial |
$27.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.98
|
| Rate for Payer: Ohio Health Group HMO |
$23.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.86
|
| Rate for Payer: PHCS Commercial |
$30.53
|
| Rate for Payer: United Healthcare All Payer |
$27.98
|
|
|
CATH IN 24G*5/8 ACUVANCE
|
Facility
|
OP
|
$31.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Anthem Medicaid |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.80
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: First Health Commercial |
$30.21
|
| Rate for Payer: Humana Commercial |
$27.03
|
| Rate for Payer: Humana KY Medicaid |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.98
|
| Rate for Payer: Ohio Health Group HMO |
$23.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9.86
|
| Rate for Payer: PHCS Commercial |
$30.53
|
| Rate for Payer: United Healthcare All Payer |
$27.98
|
| Rate for Payer: Aetna Commercial |
$24.49
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$15,499.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
76101447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,014.94 |
| Max. Negotiated Rate |
$14,879.52 |
| Rate for Payer: Aetna Commercial |
$11,934.62
|
| Rate for Payer: Anthem Medicaid |
$5,330.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,089.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cigna Commercial |
$12,864.58
|
| Rate for Payer: First Health Commercial |
$14,724.52
|
| Rate for Payer: Humana Commercial |
$13,174.58
|
| Rate for Payer: Humana KY Medicaid |
$5,330.28
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,709.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,438.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$11,624.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,099.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,804.84
|
| Rate for Payer: PHCS Commercial |
$14,879.52
|
| Rate for Payer: United Healthcare All Payer |
$13,639.56
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
761P1447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.33 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.33
|
| Rate for Payer: Anthem Medicaid |
$278.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,500.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Healthspan PPO |
$2,021.52
|
| Rate for Payer: Humana Medicaid |
$278.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.05
|
| Rate for Payer: Molina Healthcare Passport |
$278.48
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,450.00
|
| Rate for Payer: UHCCP Medicaid |
$211.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.26
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$11,999.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
761T1447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,559.94 |
| Max. Negotiated Rate |
$11,519.52 |
| Rate for Payer: Aetna Commercial |
$9,239.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,359.61
|
| Rate for Payer: Cash Price |
$5,999.75
|
| Rate for Payer: Cigna Commercial |
$9,959.58
|
| Rate for Payer: First Health Commercial |
$11,399.52
|
| Rate for Payer: Humana Commercial |
$10,199.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,839.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,855.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,599.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,559.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,999.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,399.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,559.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,719.84
|
| Rate for Payer: PHCS Commercial |
$11,519.52
|
| Rate for Payer: United Healthcare All Payer |
$10,559.56
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Professional
|
Both
|
$15,499.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
76101447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.33 |
| Max. Negotiated Rate |
$15,499.50 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.33
|
| Rate for Payer: Anthem Medicaid |
$278.48
|
| Rate for Payer: Buckeye Medicare Advantage |
$15,499.50
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Healthspan PPO |
$2,021.52
|
| Rate for Payer: Humana Medicaid |
$278.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.52
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.05
|
| Rate for Payer: Molina Healthcare Passport |
$278.48
|
| Rate for Payer: Multiplan PHCS |
$9,299.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$10,849.65
|
| Rate for Payer: UHCCP Medicaid |
$211.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.26
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$11,999.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
761T1447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,559.94 |
| Max. Negotiated Rate |
$11,519.52 |
| Rate for Payer: Aetna Commercial |
$9,239.62
|
| Rate for Payer: Anthem Medicaid |
$4,126.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,359.61
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$5,999.75
|
| Rate for Payer: Cash Price |
$5,999.75
|
| Rate for Payer: Cigna Commercial |
$9,959.58
|
| Rate for Payer: First Health Commercial |
$11,399.52
|
| Rate for Payer: Humana Commercial |
$10,199.58
|
| Rate for Payer: Humana KY Medicaid |
$4,126.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,168.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,839.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,855.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,209.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,559.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,999.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,399.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,559.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,719.84
|
| Rate for Payer: PHCS Commercial |
$11,519.52
|
| Rate for Payer: United Healthcare All Payer |
$10,559.56
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
36000040
|
|
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 INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,652.97
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,415.36
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$15,499.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
76101447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,014.94 |
| Max. Negotiated Rate |
$14,879.52 |
| Rate for Payer: Aetna Commercial |
$11,934.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,089.61
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cigna Commercial |
$12,864.58
|
| Rate for Payer: First Health Commercial |
$14,724.52
|
| Rate for Payer: Humana Commercial |
$13,174.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,709.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,438.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,649.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$11,624.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,099.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,014.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,804.84
|
| Rate for Payer: PHCS Commercial |
$14,879.52
|
| Rate for Payer: United Healthcare All Payer |
$13,639.56
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
48100018
|
|
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 LAB LEVEL 1 PER 15 MIN
|
Facility
|
IP
|
$1,200.00
|
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CATH LAB LEVEL 1 PER 15 MIN
|
Facility
|
OP
|
$1,200.00
|
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$1,152.00 |
| Rate for Payer: Aetna Commercial |
$924.00
|
| Rate for Payer: Anthem Medicaid |
$412.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$936.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$996.00
|
| Rate for Payer: First Health Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial |
$1,020.00
|
| Rate for Payer: Humana KY Medicaid |
$412.68
|
| Rate for Payer: Kentucky WC Medicaid |
$416.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$984.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$885.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$360.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,056.00
|
| Rate for Payer: Ohio Health Group HMO |
$900.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$156.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$372.00
|
| Rate for Payer: PHCS Commercial |
$1,152.00
|
| Rate for Payer: United Healthcare All Payer |
$1,056.00
|
|
|
CATH LAB LEVEL 2 PER 15 MIN
|
Facility
|
OP
|
$2,734.00
|
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$2,624.64 |
| Rate for Payer: Aetna Commercial |
$2,105.18
|
| Rate for Payer: Anthem Medicaid |
$940.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,132.52
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,269.22
|
| Rate for Payer: First Health Commercial |
$2,597.30
|
| Rate for Payer: Humana Commercial |
$2,323.90
|
| Rate for Payer: Humana KY Medicaid |
$940.22
|
| Rate for Payer: Kentucky WC Medicaid |
$949.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,241.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,017.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$959.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,405.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,050.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$546.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$847.54
|
| Rate for Payer: PHCS Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Payer |
$2,405.92
|
|
|
CATH LAB LEVEL 2 PER 15 MIN
|
Facility
|
IP
|
$2,734.00
|
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$355.42 |
| Max. Negotiated Rate |
$2,624.64 |
| Rate for Payer: Aetna Commercial |
$2,105.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,132.52
|
| Rate for Payer: Cash Price |
$1,367.00
|
| Rate for Payer: Cigna Commercial |
$2,269.22
|
| Rate for Payer: First Health Commercial |
$2,597.30
|
| Rate for Payer: Humana Commercial |
$2,323.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,241.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,017.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$820.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,405.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,050.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$546.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$355.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$847.54
|
| Rate for Payer: PHCS Commercial |
$2,624.64
|
| Rate for Payer: United Healthcare All Payer |
$2,405.92
|
|
|
CATH LAB LEVEL 3 PER 15 MIN
|
Facility
|
OP
|
$3,989.00
|
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$518.57 |
| Max. Negotiated Rate |
$3,829.44 |
| Rate for Payer: Aetna Commercial |
$3,071.53
|
| Rate for Payer: Anthem Medicaid |
$1,371.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.42
|
| Rate for Payer: Cash Price |
$1,994.50
|
| Rate for Payer: Cigna Commercial |
$3,310.87
|
| Rate for Payer: First Health Commercial |
$3,789.55
|
| Rate for Payer: Humana Commercial |
$3,390.65
|
| Rate for Payer: Humana KY Medicaid |
$1,371.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,399.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,510.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.59
|
| Rate for Payer: PHCS Commercial |
$3,829.44
|
| Rate for Payer: United Healthcare All Payer |
$3,510.32
|
|
|
CATH LAB LEVEL 3 PER 15 MIN
|
Facility
|
IP
|
$3,989.00
|
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$518.57 |
| Max. Negotiated Rate |
$3,829.44 |
| Rate for Payer: Aetna Commercial |
$3,071.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,111.42
|
| Rate for Payer: Cash Price |
$1,994.50
|
| Rate for Payer: Cigna Commercial |
$3,310.87
|
| Rate for Payer: First Health Commercial |
$3,789.55
|
| Rate for Payer: Humana Commercial |
$3,390.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,270.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,943.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,510.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,991.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,236.59
|
| Rate for Payer: PHCS Commercial |
$3,829.44
|
| Rate for Payer: United Healthcare All Payer |
$3,510.32
|
|
|
CATH LAB LEVEL 4 PER 15 MIN
|
Facility
|
IP
|
$4,260.00
|
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
CATH LAB LEVEL 4 PER 15 MIN
|
Facility
|
OP
|
$4,260.00
|
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$553.80 |
| Max. Negotiated Rate |
$4,089.60 |
| Rate for Payer: Aetna Commercial |
$3,280.20
|
| Rate for Payer: Anthem Medicaid |
$1,465.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.80
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$3,535.80
|
| Rate for Payer: First Health Commercial |
$4,047.00
|
| Rate for Payer: Humana Commercial |
$3,621.00
|
| Rate for Payer: Humana KY Medicaid |
$1,465.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$852.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.60
|
| Rate for Payer: PHCS Commercial |
$4,089.60
|
| Rate for Payer: United Healthcare All Payer |
$3,748.80
|
|
|
CATH LAB LEVEL 5 PER 15 MIN
|
Facility
|
OP
|
$7,097.00
|
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$922.61 |
| Max. Negotiated Rate |
$6,813.12 |
| Rate for Payer: Aetna Commercial |
$5,464.69
|
| Rate for Payer: Anthem Medicaid |
$2,440.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.66
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cigna Commercial |
$5,890.51
|
| Rate for Payer: First Health Commercial |
$6,742.15
|
| Rate for Payer: Humana Commercial |
$6,032.45
|
| Rate for Payer: Humana KY Medicaid |
$2,440.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,465.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,129.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,489.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,245.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,200.07
|
| Rate for Payer: PHCS Commercial |
$6,813.12
|
| Rate for Payer: United Healthcare All Payer |
$6,245.36
|
|
|
CATH LAB LEVEL 5 PER 15 MIN
|
Facility
|
IP
|
$7,097.00
|
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$922.61 |
| Max. Negotiated Rate |
$6,813.12 |
| Rate for Payer: Aetna Commercial |
$5,464.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,535.66
|
| Rate for Payer: Cash Price |
$3,548.50
|
| Rate for Payer: Cigna Commercial |
$5,890.51
|
| Rate for Payer: First Health Commercial |
$6,742.15
|
| Rate for Payer: Humana Commercial |
$6,032.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,819.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,237.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,129.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,245.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,322.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,419.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,200.07
|
| Rate for Payer: PHCS Commercial |
$6,813.12
|
| Rate for Payer: United Healthcare All Payer |
$6,245.36
|
|
|
CATH LAB LEVEL 6 PER15MIN SPPX
|
Facility
|
OP
|
$4,950.00
|
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$4,752.00 |
| Rate for Payer: Aetna Commercial |
$3,811.50
|
| Rate for Payer: Anthem Medicaid |
$1,702.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,861.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna Commercial |
$4,108.50
|
| Rate for Payer: First Health Commercial |
$4,702.50
|
| Rate for Payer: Humana Commercial |
$4,207.50
|
| Rate for Payer: Humana KY Medicaid |
$1,702.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,719.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,059.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,485.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,736.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,356.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.50
|
| Rate for Payer: PHCS Commercial |
$4,752.00
|
| Rate for Payer: United Healthcare All Payer |
$4,356.00
|
|
|
CATH LAB LEVEL 6 PER15MIN SPPX
|
Facility
|
IP
|
$4,950.00
|
|
| Hospital Charge Code |
48100098
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$643.50 |
| Max. Negotiated Rate |
$4,752.00 |
| Rate for Payer: Aetna Commercial |
$3,811.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,861.00
|
| Rate for Payer: Cash Price |
$2,475.00
|
| Rate for Payer: Cigna Commercial |
$4,108.50
|
| Rate for Payer: First Health Commercial |
$4,702.50
|
| Rate for Payer: Humana Commercial |
$4,207.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,059.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,485.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,356.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$990.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.50
|
| Rate for Payer: PHCS Commercial |
$4,752.00
|
| Rate for Payer: United Healthcare All Payer |
$4,356.00
|
|
