|
CATH COR ART W/INJ & S&I
|
Facility
|
IP
|
$12,375.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
76102478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,712.50 |
| Max. Negotiated Rate |
$11,880.00 |
| Rate for Payer: Aetna Commercial |
$9,528.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,652.50
|
| Rate for Payer: Cash Price |
$6,187.50
|
| Rate for Payer: Cigna Commercial |
$10,271.25
|
| Rate for Payer: First Health Commercial |
$11,756.25
|
| Rate for Payer: Humana Commercial |
$10,518.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,147.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,132.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,712.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,890.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,281.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,900.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,766.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,538.75
|
| Rate for Payer: PHCS Commercial |
$11,880.00
|
| Rate for Payer: United Healthcare All Payer |
$10,890.00
|
|
|
CATH COR ART W/INJ & S&I
|
Facility
|
IP
|
$12,250.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
48100065
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,675.00 |
| Max. Negotiated Rate |
$11,760.00 |
| Rate for Payer: Aetna Commercial |
$9,432.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,555.00
|
| Rate for Payer: Cash Price |
$6,125.00
|
| Rate for Payer: Cigna Commercial |
$10,167.50
|
| Rate for Payer: First Health Commercial |
$11,637.50
|
| Rate for Payer: Humana Commercial |
$10,412.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,045.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,040.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,675.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,780.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,800.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,657.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.50
|
| Rate for Payer: PHCS Commercial |
$11,760.00
|
| Rate for Payer: United Healthcare All Payer |
$10,780.00
|
|
|
CATH COR ART W/INJ & S&I
|
Professional
|
Both
|
$12,375.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
76102478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$357.37 |
| Max. Negotiated Rate |
$7,425.00 |
| Rate for Payer: Aetna Commercial |
$1,370.99
|
| Rate for Payer: Ambetter Exchange |
$777.99
|
| Rate for Payer: Anthem Medicaid |
$763.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$933.59
|
| Rate for Payer: Cash Price |
$6,187.50
|
| Rate for Payer: Cash Price |
$6,187.50
|
| Rate for Payer: Cigna Commercial |
$1,501.73
|
| Rate for Payer: Healthspan PPO |
$1,019.65
|
| Rate for Payer: Humana Medicaid |
$763.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$777.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$778.68
|
| Rate for Payer: Molina Healthcare Passport |
$763.41
|
| Rate for Payer: Multiplan PHCS |
$7,425.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,011.39
|
| Rate for Payer: UHCCP Medicaid |
$4,331.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$771.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.99
|
|
|
CATH COR ART W/INJ & S&I(P
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
761P2478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$1,501.73 |
| Rate for Payer: Aetna Commercial |
$1,370.99
|
| Rate for Payer: Ambetter Exchange |
$777.99
|
| Rate for Payer: Anthem Medicaid |
$763.41
|
| Rate for Payer: Buckeye Individual/Medicaid |
$777.99
|
| Rate for Payer: Buckeye Medicare Advantage |
$777.99
|
| Rate for Payer: CareSource Just4Me Medicare |
$933.59
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cigna Commercial |
$1,501.73
|
| Rate for Payer: Healthspan PPO |
$1,019.65
|
| Rate for Payer: Humana Medicaid |
$763.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$357.37
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$777.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$777.99
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$778.68
|
| Rate for Payer: Molina Healthcare Passport |
$763.41
|
| Rate for Payer: Multiplan PHCS |
$282.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,011.39
|
| Rate for Payer: UHCCP Medicaid |
$164.50
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$771.04
|
| Rate for Payer: Wellcare Medicare Advantage |
$777.99
|
|
|
CATH COR ART W/INJ & S&I(T
|
Facility
|
IP
|
$11,905.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
761T2478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,571.50 |
| Max. Negotiated Rate |
$11,428.80 |
| Rate for Payer: Aetna Commercial |
$9,166.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,285.90
|
| Rate for Payer: Cash Price |
$5,952.50
|
| Rate for Payer: Cigna Commercial |
$9,881.15
|
| Rate for Payer: First Health Commercial |
$11,309.75
|
| Rate for Payer: Humana Commercial |
$10,119.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,762.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,785.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,571.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,476.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,928.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,357.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,214.45
|
| Rate for Payer: PHCS Commercial |
$11,428.80
|
| Rate for Payer: United Healthcare All Payer |
$10,476.40
|
|
|
CATH COR ART W/INJ & S&I(T
|
Facility
|
OP
|
$11,905.00
|
|
|
Service Code
|
HCPCS 93454
|
| Hospital Charge Code |
761T2478
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,971.90 |
| Max. Negotiated Rate |
$11,428.80 |
| Rate for Payer: Aetna Commercial |
$9,166.85
|
| Rate for Payer: Anthem Medicaid |
$4,094.13
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,971.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,285.90
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$4,160.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$4,012.07
|
| Rate for Payer: Cash Price |
$5,952.50
|
| Rate for Payer: Cash Price |
$5,952.50
|
| Rate for Payer: Cigna Commercial |
$9,881.15
|
| Rate for Payer: First Health Commercial |
$11,309.75
|
| Rate for Payer: Humana Commercial |
$10,119.25
|
| Rate for Payer: Humana KY Medicaid |
$4,094.13
|
| Rate for Payer: Humana Medicare Advantage |
$2,971.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,135.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,762.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,785.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,566.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,176.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,476.40
|
| Rate for Payer: Ohio Health Group HMO |
$8,928.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,524.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,357.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,214.45
|
| Rate for Payer: PHCS Commercial |
$11,428.80
|
| Rate for Payer: United Healthcare All Payer |
$10,476.40
|
|
|
CATH CPS AIM UNV SLITTABL 65CM
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CATH CPS AIM UNV SLITTABL 65CM
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.60 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,617.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,759.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,395.18
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
CATH CPS DIRECT UNIV 135CM
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem Medicaid |
$708.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Humana KY Medicaid |
$708.43
|
| Rate for Payer: Kentucky WC Medicaid |
$715.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CATH CPS DIRECT UNIV 135CM
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.00 |
| Max. Negotiated Rate |
$1,977.60 |
| Rate for Payer: Aetna Commercial |
$1,586.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Cash Price |
$1,030.00
|
| Rate for Payer: Cigna Commercial |
$1,709.80
|
| Rate for Payer: First Health Commercial |
$1,957.00
|
| Rate for Payer: Humana Commercial |
$1,751.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,648.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.40
|
| Rate for Payer: PHCS Commercial |
$1,977.60
|
| Rate for Payer: United Healthcare All Payer |
$1,812.80
|
|
|
CATH DIALYSIS 52CM
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
CATH DIALYSIS 52CM
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
CATH EMBLOTW 4FR*10MM LEMAITRE
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
CATH EMBLOTW 4FR*10MM LEMAITRE
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
CATH EMBLOTW 5FR*12MM LEMAITRE
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
CATH EMBLOTW 5FR*12MM LEMAITRE
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
CATH EMBOLECTOMY 4FR 80CM
|
Facility
|
IP
|
$1,904.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,828.03 |
| Rate for Payer: Aetna Commercial |
$1,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.28
|
| Rate for Payer: Cash Price |
$952.10
|
| Rate for Payer: Cigna Commercial |
$1,580.49
|
| Rate for Payer: First Health Commercial |
$1,808.99
|
| Rate for Payer: Humana Commercial |
$1,618.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,656.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.90
|
| Rate for Payer: PHCS Commercial |
$1,828.03
|
| Rate for Payer: United Healthcare All Payer |
$1,675.70
|
|
|
CATH EMBOLECTOMY 4FR 80CM
|
Facility
|
OP
|
$1,904.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,828.03 |
| Rate for Payer: Aetna Commercial |
$1,466.23
|
| Rate for Payer: Anthem Medicaid |
$654.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.28
|
| Rate for Payer: Cash Price |
$952.10
|
| Rate for Payer: Cigna Commercial |
$1,580.49
|
| Rate for Payer: First Health Commercial |
$1,808.99
|
| Rate for Payer: Humana Commercial |
$1,618.57
|
| Rate for Payer: Humana KY Medicaid |
$654.85
|
| Rate for Payer: Kentucky WC Medicaid |
$661.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,656.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.90
|
| Rate for Payer: PHCS Commercial |
$1,828.03
|
| Rate for Payer: United Healthcare All Payer |
$1,675.70
|
|
|
CATH EMBOL OTW 3FR*6MM LEMATRE
|
Facility
|
OP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem Medicaid |
$602.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Humana KY Medicaid |
$602.58
|
| Rate for Payer: Kentucky WC Medicaid |
$608.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
CATH EMBOL OTW 3FR*6MM LEMATRE
|
Facility
|
IP
|
$1,752.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.66 |
| Max. Negotiated Rate |
$1,682.11 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.72
|
| Rate for Payer: Cash Price |
$876.10
|
| Rate for Payer: Cigna Commercial |
$1,454.33
|
| Rate for Payer: First Health Commercial |
$1,664.59
|
| Rate for Payer: Humana Commercial |
$1,489.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,541.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.02
|
| Rate for Payer: PHCS Commercial |
$1,682.11
|
| Rate for Payer: United Healthcare All Payer |
$1,541.94
|
|
|
CATH EMB SYNTEL 5FR*80CM LF
|
Facility
|
IP
|
$1,904.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,828.03 |
| Rate for Payer: Aetna Commercial |
$1,466.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.28
|
| Rate for Payer: Cash Price |
$952.10
|
| Rate for Payer: Cigna Commercial |
$1,580.49
|
| Rate for Payer: First Health Commercial |
$1,808.99
|
| Rate for Payer: Humana Commercial |
$1,618.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,656.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.90
|
| Rate for Payer: PHCS Commercial |
$1,828.03
|
| Rate for Payer: United Healthcare All Payer |
$1,675.70
|
|
|
CATH EMB SYNTEL 5FR*80CM LF
|
Facility
|
OP
|
$1,904.20
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,828.03 |
| Rate for Payer: Aetna Commercial |
$1,466.23
|
| Rate for Payer: Anthem Medicaid |
$654.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,485.28
|
| Rate for Payer: Cash Price |
$952.10
|
| Rate for Payer: Cigna Commercial |
$1,580.49
|
| Rate for Payer: First Health Commercial |
$1,808.99
|
| Rate for Payer: Humana Commercial |
$1,618.57
|
| Rate for Payer: Humana KY Medicaid |
$654.85
|
| Rate for Payer: Kentucky WC Medicaid |
$661.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,561.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,405.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$571.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,675.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,428.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,656.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,313.90
|
| Rate for Payer: PHCS Commercial |
$1,828.03
|
| Rate for Payer: United Healthcare All Payer |
$1,675.70
|
|
|
CATH EQUISTREAM 24CM
|
Facility
|
IP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
CATH EQUISTREAM 24CM
|
Facility
|
OP
|
$3,406.25
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,021.88 |
| Max. Negotiated Rate |
$3,270.00 |
| Rate for Payer: Aetna Commercial |
$2,622.81
|
| Rate for Payer: Anthem Medicaid |
$1,171.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.88
|
| Rate for Payer: Cash Price |
$1,703.12
|
| Rate for Payer: Cigna Commercial |
$2,827.19
|
| Rate for Payer: First Health Commercial |
$3,235.94
|
| Rate for Payer: Humana Commercial |
$2,895.31
|
| Rate for Payer: Humana KY Medicaid |
$1,171.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,793.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,997.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,725.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,963.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,350.31
|
| Rate for Payer: PHCS Commercial |
$3,270.00
|
| Rate for Payer: United Healthcare All Payer |
$2,997.50
|
|
|
CATHETER 8F 50CM
|
Facility
|
IP
|
$13,372.30
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
27000008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,011.69 |
| Max. Negotiated Rate |
$12,837.41 |
| Rate for Payer: Aetna Commercial |
$10,296.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,430.39
|
| Rate for Payer: Cash Price |
$6,686.15
|
| Rate for Payer: Cigna Commercial |
$11,099.01
|
| Rate for Payer: First Health Commercial |
$12,703.68
|
| Rate for Payer: Humana Commercial |
$11,366.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,965.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,868.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,011.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,767.62
|
| Rate for Payer: Ohio Health Group HMO |
$10,029.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,697.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,633.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,226.89
|
| Rate for Payer: PHCS Commercial |
$12,837.41
|
| Rate for Payer: United Healthcare All Payer |
$11,767.62
|
|
