|
CATH ABLT HALO 360+18MM
|
Facility
|
IP
|
$8,453.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.93 |
| Max. Negotiated Rate |
$8,114.98 |
| Rate for Payer: Aetna Commercial |
$6,508.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.42
|
| Rate for Payer: Cash Price |
$4,226.55
|
| Rate for Payer: Cigna Commercial |
$7,016.07
|
| Rate for Payer: First Health Commercial |
$8,030.44
|
| Rate for Payer: Humana Commercial |
$7,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,762.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,354.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,832.64
|
| Rate for Payer: PHCS Commercial |
$8,114.98
|
| Rate for Payer: United Healthcare All Payer |
$7,438.73
|
|
|
CATH ABLT HALO 360+22MM
|
Facility
|
IP
|
$9,898.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,969.55 |
| Max. Negotiated Rate |
$9,502.56 |
| Rate for Payer: Aetna Commercial |
$7,621.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,720.83
|
| Rate for Payer: Cash Price |
$4,949.25
|
| Rate for Payer: Cigna Commercial |
$8,215.75
|
| Rate for Payer: First Health Commercial |
$9,403.58
|
| Rate for Payer: Humana Commercial |
$8,413.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,116.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,710.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,423.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,611.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,829.97
|
| Rate for Payer: PHCS Commercial |
$9,502.56
|
| Rate for Payer: United Healthcare All Payer |
$8,710.68
|
|
|
CATH ABLT HALO 360+22MM
|
Facility
|
OP
|
$9,898.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,969.55 |
| Max. Negotiated Rate |
$9,502.56 |
| Rate for Payer: Aetna Commercial |
$7,621.85
|
| Rate for Payer: Anthem Medicaid |
$3,404.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,720.83
|
| Rate for Payer: Cash Price |
$4,949.25
|
| Rate for Payer: Cigna Commercial |
$8,215.75
|
| Rate for Payer: First Health Commercial |
$9,403.58
|
| Rate for Payer: Humana Commercial |
$8,413.73
|
| Rate for Payer: Humana KY Medicaid |
$3,404.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,438.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,116.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,710.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,423.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,611.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,829.97
|
| Rate for Payer: PHCS Commercial |
$9,502.56
|
| Rate for Payer: United Healthcare All Payer |
$8,710.68
|
|
|
CATH ABLT HALO 360+25MM
|
Facility
|
OP
|
$8,453.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.93 |
| Max. Negotiated Rate |
$8,114.98 |
| Rate for Payer: Aetna Commercial |
$6,508.89
|
| Rate for Payer: Anthem Medicaid |
$2,907.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.42
|
| Rate for Payer: Cash Price |
$4,226.55
|
| Rate for Payer: Cigna Commercial |
$7,016.07
|
| Rate for Payer: First Health Commercial |
$8,030.44
|
| Rate for Payer: Humana Commercial |
$7,185.14
|
| Rate for Payer: Humana KY Medicaid |
$2,907.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,965.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,762.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,354.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,832.64
|
| Rate for Payer: PHCS Commercial |
$8,114.98
|
| Rate for Payer: United Healthcare All Payer |
$7,438.73
|
|
|
CATH ABLT HALO 360+25MM
|
Facility
|
IP
|
$8,453.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.93 |
| Max. Negotiated Rate |
$8,114.98 |
| Rate for Payer: Aetna Commercial |
$6,508.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.42
|
| Rate for Payer: Cash Price |
$4,226.55
|
| Rate for Payer: Cigna Commercial |
$7,016.07
|
| Rate for Payer: First Health Commercial |
$8,030.44
|
| Rate for Payer: Humana Commercial |
$7,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,762.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,354.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,832.64
|
| Rate for Payer: PHCS Commercial |
$8,114.98
|
| Rate for Payer: United Healthcare All Payer |
$7,438.73
|
|
|
CATH ABLT HALO 360+28MM
|
Facility
|
OP
|
$9,898.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,969.55 |
| Max. Negotiated Rate |
$9,502.56 |
| Rate for Payer: Aetna Commercial |
$7,621.85
|
| Rate for Payer: Anthem Medicaid |
$3,404.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,720.83
|
| Rate for Payer: Cash Price |
$4,949.25
|
| Rate for Payer: Cigna Commercial |
$8,215.75
|
| Rate for Payer: First Health Commercial |
$9,403.58
|
| Rate for Payer: Humana Commercial |
$8,413.73
|
| Rate for Payer: Humana KY Medicaid |
$3,404.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,438.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,116.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,710.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,423.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,611.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,829.97
|
| Rate for Payer: PHCS Commercial |
$9,502.56
|
| Rate for Payer: United Healthcare All Payer |
$8,710.68
|
|
|
CATH ABLT HALO 360+28MM
|
Facility
|
IP
|
$9,898.50
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,969.55 |
| Max. Negotiated Rate |
$9,502.56 |
| Rate for Payer: Aetna Commercial |
$7,621.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,720.83
|
| Rate for Payer: Cash Price |
$4,949.25
|
| Rate for Payer: Cigna Commercial |
$8,215.75
|
| Rate for Payer: First Health Commercial |
$9,403.58
|
| Rate for Payer: Humana Commercial |
$8,413.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,116.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,710.68
|
| Rate for Payer: Ohio Health Group HMO |
$7,423.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,918.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,611.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,829.97
|
| Rate for Payer: PHCS Commercial |
$9,502.56
|
| Rate for Payer: United Healthcare All Payer |
$8,710.68
|
|
|
CATH ABLT HALO 360+31MM
|
Facility
|
OP
|
$8,453.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.93 |
| Max. Negotiated Rate |
$8,114.98 |
| Rate for Payer: Aetna Commercial |
$6,508.89
|
| Rate for Payer: Anthem Medicaid |
$2,907.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.42
|
| Rate for Payer: Cash Price |
$4,226.55
|
| Rate for Payer: Cigna Commercial |
$7,016.07
|
| Rate for Payer: First Health Commercial |
$8,030.44
|
| Rate for Payer: Humana Commercial |
$7,185.14
|
| Rate for Payer: Humana KY Medicaid |
$2,907.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,965.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,762.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,354.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,832.64
|
| Rate for Payer: PHCS Commercial |
$8,114.98
|
| Rate for Payer: United Healthcare All Payer |
$7,438.73
|
|
|
CATH ABLT HALO 360+31MM
|
Facility
|
IP
|
$8,453.10
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,535.93 |
| Max. Negotiated Rate |
$8,114.98 |
| Rate for Payer: Aetna Commercial |
$6,508.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.42
|
| Rate for Payer: Cash Price |
$4,226.55
|
| Rate for Payer: Cigna Commercial |
$7,016.07
|
| Rate for Payer: First Health Commercial |
$8,030.44
|
| Rate for Payer: Humana Commercial |
$7,185.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,762.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,354.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,832.64
|
| Rate for Payer: PHCS Commercial |
$8,114.98
|
| Rate for Payer: United Healthcare All Payer |
$7,438.73
|
|
|
CATH ABLT HALO60
|
Facility
|
OP
|
$8,416.60
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,524.98 |
| Max. Negotiated Rate |
$8,079.94 |
| Rate for Payer: Aetna Commercial |
$6,480.78
|
| Rate for Payer: Anthem Medicaid |
$2,894.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.95
|
| Rate for Payer: Cash Price |
$4,208.30
|
| Rate for Payer: Cigna Commercial |
$6,985.78
|
| Rate for Payer: First Health Commercial |
$7,995.77
|
| Rate for Payer: Humana Commercial |
$7,154.11
|
| Rate for Payer: Humana KY Medicaid |
$2,894.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,901.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,211.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,406.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,312.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,733.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,322.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,807.45
|
| Rate for Payer: PHCS Commercial |
$8,079.94
|
| Rate for Payer: United Healthcare All Payer |
$7,406.61
|
|
|
CATH ABLT HALO60
|
Facility
|
IP
|
$8,416.60
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,524.98 |
| Max. Negotiated Rate |
$8,079.94 |
| Rate for Payer: Aetna Commercial |
$6,480.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,564.95
|
| Rate for Payer: Cash Price |
$4,208.30
|
| Rate for Payer: Cigna Commercial |
$6,985.78
|
| Rate for Payer: First Health Commercial |
$7,995.77
|
| Rate for Payer: Humana Commercial |
$7,154.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,901.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,211.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,406.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,312.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,733.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,322.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,807.45
|
| Rate for Payer: PHCS Commercial |
$8,079.94
|
| Rate for Payer: United Healthcare All Payer |
$7,406.61
|
|
|
CATH ABLT HALO90
|
Facility
|
IP
|
$8,318.05
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,495.41 |
| Max. Negotiated Rate |
$7,985.33 |
| Rate for Payer: Aetna Commercial |
$6,404.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,488.08
|
| Rate for Payer: Cash Price |
$4,159.02
|
| Rate for Payer: Cigna Commercial |
$6,903.98
|
| Rate for Payer: First Health Commercial |
$7,902.15
|
| Rate for Payer: Humana Commercial |
$7,070.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,238.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,739.45
|
| Rate for Payer: PHCS Commercial |
$7,985.33
|
| Rate for Payer: United Healthcare All Payer |
$7,319.88
|
|
|
CATH ABLT HALO90
|
Facility
|
OP
|
$8,318.05
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
27000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,495.41 |
| Max. Negotiated Rate |
$7,985.33 |
| Rate for Payer: Aetna Commercial |
$6,404.90
|
| Rate for Payer: Anthem Medicaid |
$2,860.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,488.08
|
| Rate for Payer: Cash Price |
$4,159.02
|
| Rate for Payer: Cigna Commercial |
$6,903.98
|
| Rate for Payer: First Health Commercial |
$7,902.15
|
| Rate for Payer: Humana Commercial |
$7,070.34
|
| Rate for Payer: Humana KY Medicaid |
$2,860.58
|
| Rate for Payer: Kentucky WC Medicaid |
$2,889.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,820.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,138.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,495.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,917.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,319.88
|
| Rate for Payer: Ohio Health Group HMO |
$6,238.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,654.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,236.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,739.45
|
| Rate for Payer: PHCS Commercial |
$7,985.33
|
| Rate for Payer: United Healthcare All Payer |
$7,319.88
|
|
|
CATH ABLT HALO90 ULTRA
|
Facility
|
IP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
CATH ABLT HALO90 ULTRA
|
Facility
|
OP
|
$10,843.67
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,253.10 |
| Max. Negotiated Rate |
$10,409.92 |
| Rate for Payer: Aetna Commercial |
$8,349.63
|
| Rate for Payer: Anthem Medicaid |
$3,729.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,458.06
|
| Rate for Payer: Cash Price |
$5,421.84
|
| Rate for Payer: Cigna Commercial |
$9,000.25
|
| Rate for Payer: First Health Commercial |
$10,301.49
|
| Rate for Payer: Humana Commercial |
$9,217.12
|
| Rate for Payer: Humana KY Medicaid |
$3,729.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,767.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,891.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,002.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,253.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,803.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,542.43
|
| Rate for Payer: Ohio Health Group HMO |
$8,132.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,674.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,433.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,482.13
|
| Rate for Payer: PHCS Commercial |
$10,409.92
|
| Rate for Payer: United Healthcare All Payer |
$9,542.43
|
|
|
CATH ACUITY GUIDING 55CM/49CM
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH ACUITY GUIDING 55CM/49CM
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
CATH ANGLED TAPER 5FR*100CM
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem Medicaid |
$404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Humana KY Medicaid |
$404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$408.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$412.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
CATH ANGLED TAPER 5FR*100CM
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$904.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$916.50
|
| Rate for Payer: Cash Price |
$587.50
|
| Rate for Payer: Cigna Commercial |
$975.25
|
| Rate for Payer: First Health Commercial |
$1,116.25
|
| Rate for Payer: Humana Commercial |
$998.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$963.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$867.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,034.00
|
| Rate for Payer: Ohio Health Group HMO |
$881.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,022.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$810.75
|
| Rate for Payer: PHCS Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare All Payer |
$1,034.00
|
|
|
CATH ANGLED TAPER 5FR*65CM
|
Facility
|
OP
|
$842.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem Medicaid |
$289.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Humana KY Medicaid |
$289.82
|
| Rate for Payer: Kentucky WC Medicaid |
$292.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$295.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
CATH ANGLED TAPER 5FR*65CM
|
Facility
|
IP
|
$842.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.82 |
| Max. Negotiated Rate |
$809.04 |
| Rate for Payer: Aetna Commercial |
$648.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$657.35
|
| Rate for Payer: Cash Price |
$421.38
|
| Rate for Payer: Cigna Commercial |
$699.48
|
| Rate for Payer: First Health Commercial |
$800.61
|
| Rate for Payer: Humana Commercial |
$716.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$691.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$621.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$252.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$741.62
|
| Rate for Payer: Ohio Health Group HMO |
$632.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.50
|
| Rate for Payer: PHCS Commercial |
$809.04
|
| Rate for Payer: United Healthcare All Payer |
$741.62
|
|
|
CATH ASCENDA INTRATHECAL 114CM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CATH ASCENDA INTRATHECAL 114CM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CATH ASCENDA INTRATHECAL 140CM
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
CATH ASCENDA INTRATHECAL 140CM
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
