|
CATH PVC SOFT 24FR STR
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
48100019
|
|
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 SBCLVN OR INNOMIN UNIL
|
Facility
|
IP
|
$11,279.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
76101448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,466.36 |
| Max. Negotiated Rate |
$10,828.51 |
| Rate for Payer: Aetna Commercial |
$8,685.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,798.17
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cigna Commercial |
$9,362.15
|
| Rate for Payer: First Health Commercial |
$10,715.72
|
| Rate for Payer: Humana Commercial |
$9,587.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,249.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,324.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,383.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,926.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,459.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,255.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,466.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,496.71
|
| Rate for Payer: PHCS Commercial |
$10,828.51
|
| Rate for Payer: United Healthcare All Payer |
$9,926.14
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
48100019
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,639.17 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,521.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,908.79
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Facility
|
OP
|
$11,279.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
76101448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,466.36 |
| Max. Negotiated Rate |
$10,828.51 |
| Rate for Payer: Aetna Commercial |
$8,685.37
|
| Rate for Payer: Anthem Medicaid |
$3,879.09
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,798.17
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cigna Commercial |
$9,362.15
|
| Rate for Payer: First Health Commercial |
$10,715.72
|
| Rate for Payer: Humana Commercial |
$9,587.74
|
| Rate for Payer: Humana KY Medicaid |
$3,879.09
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,249.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,324.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,956.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,926.14
|
| Rate for Payer: Ohio Health Group HMO |
$8,459.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,255.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,466.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,496.71
|
| Rate for Payer: PHCS Commercial |
$10,828.51
|
| Rate for Payer: United Healthcare All Payer |
$9,926.14
|
|
|
CATH SBCLVN OR INNOMIN UNIL
|
Professional
|
Both
|
$11,279.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
76101448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$11,279.70 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.45
|
| Rate for Payer: Anthem Medicaid |
$254.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$11,279.70
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cash Price |
$5,639.85
|
| Rate for Payer: Cigna Commercial |
$588.27
|
| Rate for Payer: Healthspan PPO |
$1,846.39
|
| Rate for Payer: Humana Medicaid |
$254.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.52
|
| Rate for Payer: Molina Healthcare Passport |
$254.43
|
| Rate for Payer: Multiplan PHCS |
$6,767.82
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$7,895.79
|
| Rate for Payer: UHCCP Medicaid |
$193.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.97
|
|
|
CATH SBCLVN OR INNOMIN UNIL(P
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
761P1448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$184.45 |
| Max. Negotiated Rate |
$3,275.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$184.45
|
| Rate for Payer: Anthem Medicaid |
$254.43
|
| Rate for Payer: Buckeye Medicare Advantage |
$3,275.00
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$588.27
|
| Rate for Payer: Healthspan PPO |
$1,846.39
|
| Rate for Payer: Humana Medicaid |
$254.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$399.02
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$259.52
|
| Rate for Payer: Molina Healthcare Passport |
$254.43
|
| Rate for Payer: Multiplan PHCS |
$1,965.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$2,292.50
|
| Rate for Payer: UHCCP Medicaid |
$193.67
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$256.97
|
|
|
CATH SBCLVN OR INNOMIN UNIL(T
|
Facility
|
OP
|
$8,004.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
761T1448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,040.61 |
| Max. Negotiated Rate |
$7,684.51 |
| Rate for Payer: Aetna Commercial |
$6,163.62
|
| Rate for Payer: Anthem Medicaid |
$2,752.82
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,243.67
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$4,002.35
|
| Rate for Payer: Cash Price |
$4,002.35
|
| Rate for Payer: Cigna Commercial |
$6,643.90
|
| Rate for Payer: First Health Commercial |
$7,604.46
|
| Rate for Payer: Humana Commercial |
$6,804.00
|
| Rate for Payer: Humana KY Medicaid |
$2,752.82
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,780.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,563.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.46
|
| Rate for Payer: PHCS Commercial |
$7,684.51
|
| Rate for Payer: United Healthcare All Payer |
$7,044.14
|
|
|
CATH SBCLVN OR INNOMIN UNIL(T
|
Facility
|
IP
|
$8,004.70
|
|
|
Service Code
|
HCPCS 36225
|
| Hospital Charge Code |
761T1448
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,040.61 |
| Max. Negotiated Rate |
$7,684.51 |
| Rate for Payer: Aetna Commercial |
$6,163.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,243.67
|
| Rate for Payer: Cash Price |
$4,002.35
|
| Rate for Payer: Cigna Commercial |
$6,643.90
|
| Rate for Payer: First Health Commercial |
$7,604.46
|
| Rate for Payer: Humana Commercial |
$6,804.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,563.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,907.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,044.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,003.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,481.46
|
| Rate for Payer: PHCS Commercial |
$7,684.51
|
| Rate for Payer: United Healthcare All Payer |
$7,044.14
|
|
|
CATH STR 4F 65CM
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
CATH STR 4F 65CM
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
CATH STRAIGHT TENCKHOFF 47CM
|
Facility
|
OP
|
$1,575.33
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$1,512.32 |
| Rate for Payer: Aetna Commercial |
$1,213.00
|
| Rate for Payer: Anthem Medicaid |
$541.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.76
|
| Rate for Payer: Cash Price |
$787.66
|
| Rate for Payer: Cigna Commercial |
$1,307.52
|
| Rate for Payer: First Health Commercial |
$1,496.56
|
| Rate for Payer: Humana Commercial |
$1,339.03
|
| Rate for Payer: Humana KY Medicaid |
$541.76
|
| Rate for Payer: Kentucky WC Medicaid |
$547.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.35
|
| Rate for Payer: PHCS Commercial |
$1,512.32
|
| Rate for Payer: United Healthcare All Payer |
$1,386.29
|
|
|
CATH STRAIGHT TENCKHOFF 47CM
|
Facility
|
IP
|
$1,575.33
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.79 |
| Max. Negotiated Rate |
$1,512.32 |
| Rate for Payer: Aetna Commercial |
$1,213.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,228.76
|
| Rate for Payer: Cash Price |
$787.66
|
| Rate for Payer: Cigna Commercial |
$1,307.52
|
| Rate for Payer: First Health Commercial |
$1,496.56
|
| Rate for Payer: Humana Commercial |
$1,339.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,291.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,162.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,386.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,181.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$315.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$488.35
|
| Rate for Payer: PHCS Commercial |
$1,512.32
|
| Rate for Payer: United Healthcare All Payer |
$1,386.29
|
|
|
CATH SWAN NECK COILED L 62.5CM
|
Facility
|
IP
|
$3,122.39
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.91 |
| Max. Negotiated Rate |
$2,997.49 |
| Rate for Payer: Aetna Commercial |
$2,404.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,435.46
|
| Rate for Payer: Cash Price |
$1,561.19
|
| Rate for Payer: Cigna Commercial |
$2,591.58
|
| Rate for Payer: First Health Commercial |
$2,966.27
|
| Rate for Payer: Humana Commercial |
$2,654.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,747.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,341.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$967.94
|
| Rate for Payer: PHCS Commercial |
$2,997.49
|
| Rate for Payer: United Healthcare All Payer |
$2,747.70
|
|
|
CATH SWAN NECK COILED L 62.5CM
|
Facility
|
OP
|
$3,122.39
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.91 |
| Max. Negotiated Rate |
$2,997.49 |
| Rate for Payer: Aetna Commercial |
$2,404.24
|
| Rate for Payer: Anthem Medicaid |
$1,073.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,435.46
|
| Rate for Payer: Cash Price |
$1,561.19
|
| Rate for Payer: Cigna Commercial |
$2,591.58
|
| Rate for Payer: First Health Commercial |
$2,966.27
|
| Rate for Payer: Humana Commercial |
$2,654.03
|
| Rate for Payer: Humana KY Medicaid |
$1,073.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,560.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,304.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,747.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,341.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$624.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$405.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$967.94
|
| Rate for Payer: PHCS Commercial |
$2,997.49
|
| Rate for Payer: United Healthcare All Payer |
$2,747.70
|
|
|
CATH THORACIC 20FR RT ANGLE
|
Facility
|
IP
|
$442.36
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$424.67 |
| Rate for Payer: Aetna Commercial |
$340.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.04
|
| Rate for Payer: Cash Price |
$221.18
|
| Rate for Payer: Cigna Commercial |
$367.16
|
| Rate for Payer: First Health Commercial |
$420.24
|
| Rate for Payer: Humana Commercial |
$376.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.28
|
| Rate for Payer: Ohio Health Group HMO |
$331.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.13
|
| Rate for Payer: PHCS Commercial |
$424.67
|
| Rate for Payer: United Healthcare All Payer |
$389.28
|
|
|
CATH THORACIC 20FR RT ANGLE
|
Facility
|
OP
|
$442.36
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$424.67 |
| Rate for Payer: Aetna Commercial |
$340.62
|
| Rate for Payer: Anthem Medicaid |
$152.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$345.04
|
| Rate for Payer: Cash Price |
$221.18
|
| Rate for Payer: Cigna Commercial |
$367.16
|
| Rate for Payer: First Health Commercial |
$420.24
|
| Rate for Payer: Humana Commercial |
$376.01
|
| Rate for Payer: Humana KY Medicaid |
$152.13
|
| Rate for Payer: Kentucky WC Medicaid |
$153.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$362.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$326.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$132.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$155.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$389.28
|
| Rate for Payer: Ohio Health Group HMO |
$331.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$88.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$57.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$137.13
|
| Rate for Payer: PHCS Commercial |
$424.67
|
| Rate for Payer: United Healthcare All Payer |
$389.28
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
OP
|
$4,279.00
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
48100015
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$556.27 |
| Max. Negotiated Rate |
$4,107.84 |
| Rate for Payer: Aetna Commercial |
$3,294.83
|
| Rate for Payer: Anthem Medicaid |
$1,471.55
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,337.62
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cigna Commercial |
$3,551.57
|
| Rate for Payer: First Health Commercial |
$4,065.05
|
| Rate for Payer: Humana Commercial |
$3,637.15
|
| Rate for Payer: Humana KY Medicaid |
$1,471.55
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,486.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,508.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,157.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,501.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,765.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,326.49
|
| Rate for Payer: PHCS Commercial |
$4,107.84
|
| Rate for Payer: United Healthcare All Payer |
$3,765.52
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
OP
|
$8,846.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
76101443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,149.99 |
| Max. Negotiated Rate |
$8,492.24 |
| Rate for Payer: Aetna Commercial |
$6,811.48
|
| Rate for Payer: Anthem Medicaid |
$3,042.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,899.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cigna Commercial |
$7,342.25
|
| Rate for Payer: First Health Commercial |
$8,403.78
|
| Rate for Payer: Humana Commercial |
$7,519.17
|
| Rate for Payer: Humana KY Medicaid |
$3,042.17
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$3,073.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,103.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,742.28
|
| Rate for Payer: PHCS Commercial |
$8,492.24
|
| Rate for Payer: United Healthcare All Payer |
$7,784.55
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Professional
|
Both
|
$8,846.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
76101443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$8,846.08 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.47
|
| Rate for Payer: Anthem Medicaid |
$174.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$8,846.08
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cigna Commercial |
$404.58
|
| Rate for Payer: Healthspan PPO |
$1,363.98
|
| Rate for Payer: Humana Medicaid |
$174.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.07
|
| Rate for Payer: Molina Healthcare Passport |
$174.58
|
| Rate for Payer: Multiplan PHCS |
$5,307.65
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$6,192.26
|
| Rate for Payer: UHCCP Medicaid |
$133.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.33
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
IP
|
$4,279.00
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
48100015
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$556.27 |
| Max. Negotiated Rate |
$4,107.84 |
| Rate for Payer: Aetna Commercial |
$3,294.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,337.62
|
| Rate for Payer: Cash Price |
$2,139.50
|
| Rate for Payer: Cigna Commercial |
$3,551.57
|
| Rate for Payer: First Health Commercial |
$4,065.05
|
| Rate for Payer: Humana Commercial |
$3,637.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,508.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,157.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,765.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,209.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,326.49
|
| Rate for Payer: PHCS Commercial |
$4,107.84
|
| Rate for Payer: United Healthcare All Payer |
$3,765.52
|
|
|
CATH THOR AORTA/INTRACRAN VS
|
Facility
|
IP
|
$8,846.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
76101443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,149.99 |
| Max. Negotiated Rate |
$8,492.24 |
| Rate for Payer: Aetna Commercial |
$6,811.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,899.94
|
| Rate for Payer: Cash Price |
$4,423.04
|
| Rate for Payer: Cigna Commercial |
$7,342.25
|
| Rate for Payer: First Health Commercial |
$8,403.78
|
| Rate for Payer: Humana Commercial |
$7,519.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,653.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.55
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,742.28
|
| Rate for Payer: PHCS Commercial |
$8,492.24
|
| Rate for Payer: United Healthcare All Payer |
$7,784.55
|
|
|
CATH THOR AORTA/INTRACRAN VS(P
|
Professional
|
Both
|
$1,600.00
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
761P1443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.47 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$127.47
|
| Rate for Payer: Anthem Medicaid |
$174.58
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,600.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cigna Commercial |
$404.58
|
| Rate for Payer: Healthspan PPO |
$1,363.98
|
| Rate for Payer: Humana Medicaid |
$174.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$275.76
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$178.07
|
| Rate for Payer: Molina Healthcare Passport |
$174.58
|
| Rate for Payer: Multiplan PHCS |
$960.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,120.00
|
| Rate for Payer: UHCCP Medicaid |
$133.84
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$176.33
|
|
|
CATH THOR AORTA/INTRACRAN VS(T
|
Facility
|
OP
|
$7,246.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
761T1443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$941.99 |
| Max. Negotiated Rate |
$6,956.24 |
| Rate for Payer: Aetna Commercial |
$5,579.48
|
| Rate for Payer: Anthem Medicaid |
$2,491.93
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,756.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,858.95
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,721.13
|
| Rate for Payer: Cash Price |
$3,623.04
|
| Rate for Payer: Cash Price |
$3,623.04
|
| Rate for Payer: Cigna Commercial |
$6,014.25
|
| Rate for Payer: First Health Commercial |
$6,883.78
|
| Rate for Payer: Humana Commercial |
$6,159.17
|
| Rate for Payer: Humana KY Medicaid |
$2,491.93
|
| Rate for Payer: Humana Medicare Advantage |
$2,756.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,517.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,941.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,347.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,307.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,541.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,376.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,434.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,246.28
|
| Rate for Payer: PHCS Commercial |
$6,956.24
|
| Rate for Payer: United Healthcare All Payer |
$6,376.55
|
|
|
CATH THOR AORTA/INTRACRAN VS(T
|
Facility
|
IP
|
$7,246.08
|
|
|
Service Code
|
HCPCS 36221
|
| Hospital Charge Code |
761T1443
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$941.99 |
| Max. Negotiated Rate |
$6,956.24 |
| Rate for Payer: Aetna Commercial |
$5,579.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,651.94
|
| Rate for Payer: Cash Price |
$3,623.04
|
| Rate for Payer: Cigna Commercial |
$6,014.25
|
| Rate for Payer: First Health Commercial |
$6,883.78
|
| Rate for Payer: Humana Commercial |
$6,159.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,941.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,347.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,173.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,376.55
|
| Rate for Payer: Ohio Health Group HMO |
$5,434.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$941.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,246.28
|
| Rate for Payer: PHCS Commercial |
$6,956.24
|
| Rate for Payer: United Healthcare All Payer |
$6,376.55
|
|
