|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
OP
|
$14,040.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
76101449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,825.20 |
| Max. Negotiated Rate |
$13,478.40 |
| Rate for Payer: Aetna Commercial |
$10,810.80
|
| Rate for Payer: Anthem Medicaid |
$4,828.36
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,951.20
|
| 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 |
$7,020.00
|
| Rate for Payer: Cash Price |
$7,020.00
|
| Rate for Payer: Cigna Commercial |
$11,653.20
|
| Rate for Payer: First Health Commercial |
$13,338.00
|
| Rate for Payer: Humana Commercial |
$11,934.00
|
| Rate for Payer: Humana KY Medicaid |
$4,828.36
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,877.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,512.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,361.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,925.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,355.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,352.40
|
| Rate for Payer: PHCS Commercial |
$13,478.40
|
| Rate for Payer: United Healthcare All Payer |
$12,355.20
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
IP
|
$14,040.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
76101449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,825.20 |
| Max. Negotiated Rate |
$13,478.40 |
| Rate for Payer: Aetna Commercial |
$10,810.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,951.20
|
| Rate for Payer: Cash Price |
$7,020.00
|
| Rate for Payer: Cigna Commercial |
$11,653.20
|
| Rate for Payer: First Health Commercial |
$13,338.00
|
| Rate for Payer: Humana Commercial |
$11,934.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,512.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,361.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,212.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,355.20
|
| Rate for Payer: Ohio Health Group HMO |
$10,530.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,808.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,825.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,352.40
|
| Rate for Payer: PHCS Commercial |
$13,478.40
|
| Rate for Payer: United Healthcare All Payer |
$12,355.20
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Professional
|
Both
|
$14,040.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
76101449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.68 |
| Max. Negotiated Rate |
$14,040.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.68
|
| Rate for Payer: Anthem Medicaid |
$279.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$14,040.00
|
| Rate for Payer: Cash Price |
$7,020.00
|
| Rate for Payer: Cash Price |
$7,020.00
|
| Rate for Payer: Cigna Commercial |
$644.17
|
| Rate for Payer: Healthspan PPO |
$2,061.32
|
| Rate for Payer: Humana Medicaid |
$279.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.58
|
| Rate for Payer: Molina Healthcare Passport |
$279.00
|
| Rate for Payer: Multiplan PHCS |
$8,424.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$9,828.00
|
| Rate for Payer: UHCCP Medicaid |
$211.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.79
|
|
|
CATH VERTIBRAL ART UNILATERAL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
48100020
|
|
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 VERTIBRAL ART UNILATERAL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
48100020
|
|
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 VERTIBRAL ART UNILATERA(P
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
761P1449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.68 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.68
|
| Rate for Payer: Anthem Medicaid |
$279.00
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,500.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cash Price |
$1,250.00
|
| Rate for Payer: Cigna Commercial |
$644.17
|
| Rate for Payer: Healthspan PPO |
$2,061.32
|
| Rate for Payer: Humana Medicaid |
$279.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$436.32
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$284.58
|
| Rate for Payer: Molina Healthcare Passport |
$279.00
|
| Rate for Payer: Multiplan PHCS |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,750.00
|
| Rate for Payer: UHCCP Medicaid |
$211.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$281.79
|
|
|
CATH VERTIBRAL ART UNILATERA(T
|
Facility
|
IP
|
$11,540.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
761T1449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.20 |
| Max. Negotiated Rate |
$11,078.40 |
| Rate for Payer: Aetna Commercial |
$8,885.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,001.20
|
| Rate for Payer: Cash Price |
$5,770.00
|
| Rate for Payer: Cigna Commercial |
$9,578.20
|
| Rate for Payer: First Health Commercial |
$10,963.00
|
| Rate for Payer: Humana Commercial |
$9,809.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,462.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,516.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,462.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,155.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,577.40
|
| Rate for Payer: PHCS Commercial |
$11,078.40
|
| Rate for Payer: United Healthcare All Payer |
$10,155.20
|
|
|
CATH VERTIBRAL ART UNILATERA(T
|
Facility
|
OP
|
$11,540.00
|
|
|
Service Code
|
HCPCS 36226
|
| Hospital Charge Code |
761T1449
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,500.20 |
| Max. Negotiated Rate |
$11,078.40 |
| Rate for Payer: Aetna Commercial |
$8,885.80
|
| Rate for Payer: Anthem Medicaid |
$3,968.61
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,752.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,001.20
|
| 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 |
$5,770.00
|
| Rate for Payer: Cash Price |
$5,770.00
|
| Rate for Payer: Cigna Commercial |
$9,578.20
|
| Rate for Payer: First Health Commercial |
$10,963.00
|
| Rate for Payer: Humana Commercial |
$9,809.00
|
| Rate for Payer: Humana KY Medicaid |
$3,968.61
|
| Rate for Payer: Humana Medicare Advantage |
$4,752.12
|
| Rate for Payer: Kentucky WC Medicaid |
$4,009.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,462.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,516.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,702.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,048.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,155.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,655.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,308.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,500.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,577.40
|
| Rate for Payer: PHCS Commercial |
$11,078.40
|
| Rate for Payer: United Healthcare All Payer |
$10,155.20
|
|
|
CATH XPEEDIOR 4FR*135CM
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
CATH XPEEDIOR 4FR*135CM
|
Facility
|
OP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Anthem Medicaid |
$2,751.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Humana KY Medicaid |
$2,751.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,779.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,806.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
|
|
CATH XPEEDIOR 6FR*100CM
|
Facility
|
OP
|
$6,650.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.60 |
| Max. Negotiated Rate |
$6,384.72 |
| Rate for Payer: Aetna Commercial |
$5,121.08
|
| Rate for Payer: Anthem Medicaid |
$2,287.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.58
|
| Rate for Payer: Cash Price |
$3,325.38
|
| Rate for Payer: Cigna Commercial |
$5,520.12
|
| Rate for Payer: First Health Commercial |
$6,318.21
|
| Rate for Payer: Humana Commercial |
$5,653.14
|
| Rate for Payer: Humana KY Medicaid |
$2,287.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,310.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,908.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,333.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,988.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,330.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,061.73
|
| Rate for Payer: PHCS Commercial |
$6,384.72
|
| Rate for Payer: United Healthcare All Payer |
$5,852.66
|
|
|
CATH XPEEDIOR 6FR*100CM
|
Facility
|
IP
|
$6,650.75
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.60 |
| Max. Negotiated Rate |
$6,384.72 |
| Rate for Payer: Aetna Commercial |
$5,121.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,187.58
|
| Rate for Payer: Cash Price |
$3,325.38
|
| Rate for Payer: Cigna Commercial |
$5,520.12
|
| Rate for Payer: First Health Commercial |
$6,318.21
|
| Rate for Payer: Humana Commercial |
$5,653.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,453.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,908.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,995.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,852.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,988.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,330.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$864.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,061.73
|
| Rate for Payer: PHCS Commercial |
$6,384.72
|
| Rate for Payer: United Healthcare All Payer |
$5,852.66
|
|
|
[C]ATIVAN (LORAZEPAM .5MG/1TAB
|
Facility
|
OP
|
$60.08
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
25000089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$46.26
|
| Rate for Payer: Anthem Medicaid |
$20.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.86
|
| Rate for Payer: Cash Price |
$30.04
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.08
|
| Rate for Payer: Humana Commercial |
$51.07
|
| Rate for Payer: Humana KY Medicaid |
$20.66
|
| Rate for Payer: Kentucky WC Medicaid |
$20.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$21.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.87
|
| Rate for Payer: Ohio Health Group HMO |
$45.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.62
|
| Rate for Payer: PHCS Commercial |
$57.68
|
| Rate for Payer: United Healthcare All Payer |
$52.87
|
|
|
[C]ATIVAN (LORAZEPAM .5MG/1TAB
|
Facility
|
IP
|
$60.08
|
|
|
Service Code
|
NDC 904600761
|
| Hospital Charge Code |
25000089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.81 |
| Max. Negotiated Rate |
$57.68 |
| Rate for Payer: Aetna Commercial |
$46.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$46.86
|
| Rate for Payer: Cash Price |
$30.04
|
| Rate for Payer: Cigna Commercial |
$49.87
|
| Rate for Payer: First Health Commercial |
$57.08
|
| Rate for Payer: Humana Commercial |
$51.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$49.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$44.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$18.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$52.87
|
| Rate for Payer: Ohio Health Group HMO |
$45.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$18.62
|
| Rate for Payer: PHCS Commercial |
$57.68
|
| Rate for Payer: United Healthcare All Payer |
$52.87
|
|
|
CATS 120 RESERVOIR BIO TRONIC
|
Facility
|
OP
|
$3,740.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem Medicaid |
$1,286.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Humana KY Medicaid |
$1,286.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,299.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,311.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.40
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
CATS 120 RESERVOIR BIO TRONIC
|
Facility
|
IP
|
$3,740.00
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$486.20 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.40
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$149.50 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$345.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.48
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$897.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$954.50
|
| Rate for Payer: First Health Commercial |
$1,092.50
|
| Rate for Payer: Humana Commercial |
$977.50
|
| Rate for Payer: Humana KY Medicaid |
$395.48
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$399.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$943.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,012.00
|
| Rate for Payer: Ohio Health Group HMO |
$862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$230.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
CAT SCAN FOLLOW-UP STUDY
|
Professional
|
Both
|
$1,150.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
35000016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$61.72 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Anthem Medicaid |
$136.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,150.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cash Price |
$575.00
|
| Rate for Payer: Cigna Commercial |
$283.88
|
| Rate for Payer: Healthspan PPO |
$162.55
|
| Rate for Payer: Humana Medicaid |
$136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.69
|
| Rate for Payer: Molina Healthcare Passport |
$136.95
|
| Rate for Payer: Multiplan PHCS |
$690.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$805.00
|
| Rate for Payer: UHCCP Medicaid |
$402.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.32
|
|
|
CAT SCAN FOLLOW-UP STUDY(P
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
350P0016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$283.88 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Anthem Medicaid |
$136.95
|
| Rate for Payer: Buckeye Medicare Advantage |
$150.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$283.88
|
| Rate for Payer: Healthspan PPO |
$162.55
|
| Rate for Payer: Humana Medicaid |
$136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$61.72
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$139.69
|
| Rate for Payer: Molina Healthcare Passport |
$136.95
|
| Rate for Payer: Multiplan PHCS |
$90.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$105.00
|
| Rate for Payer: UHCCP Medicaid |
$52.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$138.32
|
|
|
CAT SCAN FOLLOW-UP STUDY(T
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
350T0016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.58 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem Medicaid |
$343.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$78.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$110.01
|
| Rate for Payer: CareSource Just4Me Medicare |
$106.08
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Humana KY Medicaid |
$343.90
|
| Rate for Payer: Humana Medicare Advantage |
$78.58
|
| Rate for Payer: Kentucky WC Medicaid |
$347.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$94.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$350.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CAT SCAN FOLLOW-UP STUDY(T
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS 76380
|
| Hospital Charge Code |
350T0016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: Aetna Commercial |
$770.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$780.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cigna Commercial |
$830.00
|
| Rate for Payer: First Health Commercial |
$950.00
|
| Rate for Payer: Humana Commercial |
$850.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$820.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$738.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$300.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$880.00
|
| Rate for Payer: Ohio Health Group HMO |
$750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$200.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$130.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$310.00
|
| Rate for Payer: PHCS Commercial |
$960.00
|
| Rate for Payer: United Healthcare All Payer |
$880.00
|
|
|
CAUTERY & ABLATION
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
76101136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$37.45 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$181.82
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$79.77
|
| Rate for Payer: Anthem Medicaid |
$37.45
|
| Rate for Payer: Buckeye Medicare Advantage |
$300.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$297.80
|
| Rate for Payer: Healthspan PPO |
$251.28
|
| Rate for Payer: Humana Medicaid |
$37.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$168.16
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$38.20
|
| Rate for Payer: Molina Healthcare Passport |
$37.45
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$210.00
|
| Rate for Payer: UHCCP Medicaid |
$83.76
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$37.82
|
|
|
CAUTERY & ABLATION
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
76101136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
CAUTERY & ABLATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 30801
|
| Hospital Charge Code |
76101136
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$1,846.31 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,318.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,846.31
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,780.37
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,318.79
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$60.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$39.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$93.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
