|
CATH MAHURKAR 12*16
|
Facility
|
OP
|
$2,210.68
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.39 |
| Max. Negotiated Rate |
$2,122.25 |
| Rate for Payer: Aetna Commercial |
$1,702.22
|
| Rate for Payer: Anthem Medicaid |
$760.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.33
|
| Rate for Payer: Cash Price |
$1,105.34
|
| Rate for Payer: Cigna Commercial |
$1,834.86
|
| Rate for Payer: First Health Commercial |
$2,100.15
|
| Rate for Payer: Humana Commercial |
$1,879.08
|
| Rate for Payer: Humana KY Medicaid |
$760.25
|
| Rate for Payer: Kentucky WC Medicaid |
$767.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,812.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.31
|
| Rate for Payer: PHCS Commercial |
$2,122.25
|
| Rate for Payer: United Healthcare All Payer |
$1,945.40
|
|
|
CATH MAHURKAR 12*16
|
Facility
|
IP
|
$2,210.68
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.39 |
| Max. Negotiated Rate |
$2,122.25 |
| Rate for Payer: Aetna Commercial |
$1,702.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.33
|
| Rate for Payer: Cash Price |
$1,105.34
|
| Rate for Payer: Cigna Commercial |
$1,834.86
|
| Rate for Payer: First Health Commercial |
$2,100.15
|
| Rate for Payer: Humana Commercial |
$1,879.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,812.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.31
|
| Rate for Payer: PHCS Commercial |
$2,122.25
|
| Rate for Payer: United Healthcare All Payer |
$1,945.40
|
|
|
CATH MAHURKAR 13.5*19.5
|
Facility
|
IP
|
$1,872.44
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.42 |
| Max. Negotiated Rate |
$1,797.54 |
| Rate for Payer: Aetna Commercial |
$1,441.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.50
|
| Rate for Payer: Cash Price |
$936.22
|
| Rate for Payer: Cigna Commercial |
$1,554.13
|
| Rate for Payer: First Health Commercial |
$1,778.82
|
| Rate for Payer: Humana Commercial |
$1,591.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.46
|
| Rate for Payer: PHCS Commercial |
$1,797.54
|
| Rate for Payer: United Healthcare All Payer |
$1,647.75
|
|
|
CATH MAHURKAR 13.5*19.5
|
Facility
|
OP
|
$1,872.44
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.42 |
| Max. Negotiated Rate |
$1,797.54 |
| Rate for Payer: Aetna Commercial |
$1,441.78
|
| Rate for Payer: Anthem Medicaid |
$643.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.50
|
| Rate for Payer: Cash Price |
$936.22
|
| Rate for Payer: Cigna Commercial |
$1,554.13
|
| Rate for Payer: First Health Commercial |
$1,778.82
|
| Rate for Payer: Humana Commercial |
$1,591.57
|
| Rate for Payer: Humana KY Medicaid |
$643.93
|
| Rate for Payer: Kentucky WC Medicaid |
$650.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,404.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$580.46
|
| Rate for Payer: PHCS Commercial |
$1,797.54
|
| Rate for Payer: United Healthcare All Payer |
$1,647.75
|
|
|
CATH MAHURKAR DUAL13.5*16
|
Facility
|
IP
|
$2,060.36
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.85 |
| Max. Negotiated Rate |
$1,977.95 |
| Rate for Payer: Aetna Commercial |
$1,586.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.08
|
| Rate for Payer: Cash Price |
$1,030.18
|
| Rate for Payer: Cigna Commercial |
$1,710.10
|
| Rate for Payer: First Health Commercial |
$1,957.34
|
| Rate for Payer: Humana Commercial |
$1,751.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.71
|
| Rate for Payer: PHCS Commercial |
$1,977.95
|
| Rate for Payer: United Healthcare All Payer |
$1,813.12
|
|
|
CATH MAHURKAR DUAL13.5*16
|
Facility
|
OP
|
$2,060.36
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.85 |
| Max. Negotiated Rate |
$1,977.95 |
| Rate for Payer: Aetna Commercial |
$1,586.48
|
| Rate for Payer: Anthem Medicaid |
$708.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.08
|
| Rate for Payer: Cash Price |
$1,030.18
|
| Rate for Payer: Cigna Commercial |
$1,710.10
|
| Rate for Payer: First Health Commercial |
$1,957.34
|
| Rate for Payer: Humana Commercial |
$1,751.31
|
| Rate for Payer: Humana KY Medicaid |
$708.56
|
| Rate for Payer: Kentucky WC Medicaid |
$715.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.71
|
| Rate for Payer: PHCS Commercial |
$1,977.95
|
| Rate for Payer: United Healthcare All Payer |
$1,813.12
|
|
|
CATH MAHURKAR TRIPLE 12*20
|
Facility
|
IP
|
$2,212.86
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.67 |
| Max. Negotiated Rate |
$2,124.35 |
| Rate for Payer: Aetna Commercial |
$1,703.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,726.03
|
| Rate for Payer: Cash Price |
$1,106.43
|
| Rate for Payer: Cigna Commercial |
$1,836.67
|
| Rate for Payer: First Health Commercial |
$2,102.22
|
| Rate for Payer: Humana Commercial |
$1,880.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,814.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,633.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,947.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.99
|
| Rate for Payer: PHCS Commercial |
$2,124.35
|
| Rate for Payer: United Healthcare All Payer |
$1,947.32
|
|
|
CATH MAHURKAR TRIPLE 12*20
|
Facility
|
OP
|
$2,212.86
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.67 |
| Max. Negotiated Rate |
$2,124.35 |
| Rate for Payer: Aetna Commercial |
$1,703.90
|
| Rate for Payer: Anthem Medicaid |
$761.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,726.03
|
| Rate for Payer: Cash Price |
$1,106.43
|
| Rate for Payer: Cigna Commercial |
$1,836.67
|
| Rate for Payer: First Health Commercial |
$2,102.22
|
| Rate for Payer: Humana Commercial |
$1,880.93
|
| Rate for Payer: Humana KY Medicaid |
$761.00
|
| Rate for Payer: Kentucky WC Medicaid |
$768.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,814.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,633.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$776.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,947.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.99
|
| Rate for Payer: PHCS Commercial |
$2,124.35
|
| Rate for Payer: United Healthcare All Payer |
$1,947.32
|
|
|
CATH OPTI-FLOW PRECURVED 45CM
|
Facility
|
IP
|
$3,286.40
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.23 |
| Max. Negotiated Rate |
$3,154.94 |
| Rate for Payer: Aetna Commercial |
$2,530.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.39
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cigna Commercial |
$2,727.71
|
| Rate for Payer: First Health Commercial |
$3,122.08
|
| Rate for Payer: Humana Commercial |
$2,793.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,694.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,464.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.78
|
| Rate for Payer: PHCS Commercial |
$3,154.94
|
| Rate for Payer: United Healthcare All Payer |
$2,892.03
|
|
|
CATH OPTI-FLOW PRECURVED 45CM
|
Facility
|
OP
|
$3,286.40
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$427.23 |
| Max. Negotiated Rate |
$3,154.94 |
| Rate for Payer: Aetna Commercial |
$2,530.53
|
| Rate for Payer: Anthem Medicaid |
$1,130.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,563.39
|
| Rate for Payer: Cash Price |
$1,643.20
|
| Rate for Payer: Cigna Commercial |
$2,727.71
|
| Rate for Payer: First Health Commercial |
$3,122.08
|
| Rate for Payer: Humana Commercial |
$2,793.44
|
| Rate for Payer: Humana KY Medicaid |
$1,130.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,694.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,425.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,892.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,464.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.78
|
| Rate for Payer: PHCS Commercial |
$3,154.94
|
| Rate for Payer: United Healthcare All Payer |
$2,892.03
|
|
|
CATH PALINDROME 19CM STR
|
Facility
|
IP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.12 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.38
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
CATH PALINDROME 19CM STR
|
Facility
|
OP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.12 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem Medicaid |
$1,087.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Humana KY Medicaid |
$1,087.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.38
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
CATH PALINDROME 23CM STR
|
Facility
|
OP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.12 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem Medicaid |
$1,087.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Humana KY Medicaid |
$1,087.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.38
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
CATH PALINDROME 23CM STR
|
Facility
|
IP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.12 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.38
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
CATH PALINDROME SILVER ION 44C
|
Facility
|
OP
|
$4,376.69
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.97 |
| Max. Negotiated Rate |
$4,201.62 |
| Rate for Payer: Aetna Commercial |
$3,370.05
|
| Rate for Payer: Anthem Medicaid |
$1,505.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.82
|
| Rate for Payer: Cash Price |
$2,188.35
|
| Rate for Payer: Cigna Commercial |
$3,632.65
|
| Rate for Payer: First Health Commercial |
$4,157.86
|
| Rate for Payer: Humana Commercial |
$3,720.19
|
| Rate for Payer: Humana KY Medicaid |
$1,505.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,230.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,851.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.77
|
| Rate for Payer: PHCS Commercial |
$4,201.62
|
| Rate for Payer: United Healthcare All Payer |
$3,851.49
|
|
|
CATH PALINDROME SILVER ION 44C
|
Facility
|
IP
|
$4,376.69
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$568.97 |
| Max. Negotiated Rate |
$4,201.62 |
| Rate for Payer: Aetna Commercial |
$3,370.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.82
|
| Rate for Payer: Cash Price |
$2,188.35
|
| Rate for Payer: Cigna Commercial |
$3,632.65
|
| Rate for Payer: First Health Commercial |
$4,157.86
|
| Rate for Payer: Humana Commercial |
$3,720.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,230.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,851.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$875.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,356.77
|
| Rate for Payer: PHCS Commercial |
$4,201.62
|
| Rate for Payer: United Healthcare All Payer |
$3,851.49
|
|
|
CATH PATENCY
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32001011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.49 |
| Max. Negotiated Rate |
$1,030.08 |
| Rate for Payer: Aetna Commercial |
$826.21
|
| Rate for Payer: Anthem Medicaid |
$369.00
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$890.59
|
| Rate for Payer: First Health Commercial |
$1,019.35
|
| Rate for Payer: Humana Commercial |
$912.05
|
| Rate for Payer: Humana KY Medicaid |
$369.00
|
| Rate for Payer: Humana Medicare Advantage |
$185.35
|
| Rate for Payer: Kentucky WC Medicaid |
$372.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.24
|
| Rate for Payer: Ohio Health Group HMO |
$804.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.63
|
| Rate for Payer: PHCS Commercial |
$1,030.08
|
| Rate for Payer: United Healthcare All Payer |
$944.24
|
|
|
CATH PATENCY
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32001011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.49 |
| Max. Negotiated Rate |
$1,030.08 |
| Rate for Payer: Aetna Commercial |
$826.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.94
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$890.59
|
| Rate for Payer: First Health Commercial |
$1,019.35
|
| Rate for Payer: Humana Commercial |
$912.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.24
|
| Rate for Payer: Ohio Health Group HMO |
$804.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.63
|
| Rate for Payer: PHCS Commercial |
$1,030.08
|
| Rate for Payer: United Healthcare All Payer |
$944.24
|
|
|
CATH PATENCY
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
32001011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$1,073.00 |
| Rate for Payer: Aetna Commercial |
$93.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.85
|
| Rate for Payer: Anthem Medicaid |
$90.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,073.00
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cash Price |
$536.50
|
| Rate for Payer: Cigna Commercial |
$154.88
|
| Rate for Payer: Healthspan PPO |
$135.00
|
| Rate for Payer: Humana Medicaid |
$90.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.69
|
| Rate for Payer: Molina Healthcare Passport |
$90.87
|
| Rate for Payer: Multiplan PHCS |
$643.80
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$751.10
|
| Rate for Payer: UHCCP Medicaid |
$29.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.78
|
|
|
CATH PATENCY (P
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
320P1011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Aetna Commercial |
$93.38
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$27.85
|
| Rate for Payer: Anthem Medicaid |
$90.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$235.00
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Cigna Commercial |
$154.88
|
| Rate for Payer: Healthspan PPO |
$135.00
|
| Rate for Payer: Humana Medicaid |
$90.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$62.31
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$92.69
|
| Rate for Payer: Molina Healthcare Passport |
$90.87
|
| Rate for Payer: Multiplan PHCS |
$141.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$164.50
|
| Rate for Payer: UHCCP Medicaid |
$29.24
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$91.78
|
|
|
CATH PATENCY (T
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
320T1011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$251.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CATH PATENCY (T
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
HCPCS 36598
|
| Hospital Charge Code |
320T1011
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$804.48 |
| Rate for Payer: Aetna Commercial |
$645.26
|
| Rate for Payer: Anthem Medicaid |
$288.19
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$185.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$653.64
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$259.49
|
| Rate for Payer: CareSource Just4Me Medicare |
$250.22
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cash Price |
$419.00
|
| Rate for Payer: Cigna Commercial |
$695.54
|
| Rate for Payer: First Health Commercial |
$796.10
|
| Rate for Payer: Humana Commercial |
$712.30
|
| Rate for Payer: Humana KY Medicaid |
$288.19
|
| Rate for Payer: Humana Medicare Advantage |
$185.35
|
| Rate for Payer: Kentucky WC Medicaid |
$291.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$687.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$618.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$222.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$737.44
|
| Rate for Payer: Ohio Health Group HMO |
$628.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$167.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$108.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$259.78
|
| Rate for Payer: PHCS Commercial |
$804.48
|
| Rate for Payer: United Healthcare All Payer |
$737.44
|
|
|
CATH PRUITT OCCLUSION 4FR
|
Facility
|
IP
|
$2,207.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.98 |
| Max. Negotiated Rate |
$2,119.20 |
| Rate for Payer: Aetna Commercial |
$1,699.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.85
|
| Rate for Payer: Cash Price |
$1,103.75
|
| Rate for Payer: Cigna Commercial |
$1,832.22
|
| Rate for Payer: First Health Commercial |
$2,097.12
|
| Rate for Payer: Humana Commercial |
$1,876.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$441.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.32
|
| Rate for Payer: PHCS Commercial |
$2,119.20
|
| Rate for Payer: United Healthcare All Payer |
$1,942.60
|
|
|
CATH PRUITT OCCLUSION 4FR
|
Facility
|
OP
|
$2,207.50
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.98 |
| Max. Negotiated Rate |
$2,119.20 |
| Rate for Payer: Aetna Commercial |
$1,699.78
|
| Rate for Payer: Anthem Medicaid |
$759.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,721.85
|
| Rate for Payer: Cash Price |
$1,103.75
|
| Rate for Payer: Cigna Commercial |
$1,832.22
|
| Rate for Payer: First Health Commercial |
$2,097.12
|
| Rate for Payer: Humana Commercial |
$1,876.38
|
| Rate for Payer: Humana KY Medicaid |
$759.16
|
| Rate for Payer: Kentucky WC Medicaid |
$766.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,810.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,629.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$662.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$774.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,942.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,655.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$441.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$684.32
|
| Rate for Payer: PHCS Commercial |
$2,119.20
|
| Rate for Payer: United Healthcare All Payer |
$1,942.60
|
|
|
CATH PVC SOFT 24FR STR
|
Facility
|
OP
|
$1,128.81
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.75 |
| Max. Negotiated Rate |
$1,083.66 |
| Rate for Payer: Aetna Commercial |
$869.18
|
| Rate for Payer: Anthem Medicaid |
$388.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.47
|
| Rate for Payer: Cash Price |
$564.41
|
| Rate for Payer: Cigna Commercial |
$936.91
|
| Rate for Payer: First Health Commercial |
$1,072.37
|
| Rate for Payer: Humana Commercial |
$959.49
|
| Rate for Payer: Humana KY Medicaid |
$388.20
|
| Rate for Payer: Kentucky WC Medicaid |
$392.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$833.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.35
|
| Rate for Payer: Ohio Health Group HMO |
$846.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.93
|
| Rate for Payer: PHCS Commercial |
$1,083.66
|
| Rate for Payer: United Healthcare All Payer |
$993.35
|
|
