|
CATH EXT CAROTID UNILATERAL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36227
|
| Hospital Charge Code |
36000041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,782.70 |
| 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 |
$10,087.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,969.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,700.21
|
| Rate for Payer: PHCS Commercial |
$12,104.64
|
| Rate for Payer: United Healthcare All Payer |
$11,095.92
|
|
|
CATH FEM ARTERY SNGL LUMEN 5F
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| 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 |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
CATH FEM ARTERY SNGL LUMEN 5F
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$885.50
|
| Rate for Payer: Anthem Medicaid |
$395.49
|
| 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: Humana KY Medicaid |
$395.49
|
| 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 |
$345.00
|
| 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 |
$920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.50
|
| Rate for Payer: PHCS Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare All Payer |
$1,012.00
|
|
|
CATHFLO ACTIVASE 2MG VIAL
|
Facility
|
IP
|
$1,009.18
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$302.75 |
| Max. Negotiated Rate |
$968.81 |
| Rate for Payer: Aetna Commercial |
$777.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$787.16
|
| Rate for Payer: Cash Price |
$504.59
|
| Rate for Payer: Cigna Commercial |
$837.62
|
| Rate for Payer: First Health Commercial |
$958.72
|
| Rate for Payer: Humana Commercial |
$857.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$827.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$744.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$302.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$888.08
|
| Rate for Payer: Ohio Health Group HMO |
$756.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$877.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.33
|
| Rate for Payer: PHCS Commercial |
$968.81
|
| Rate for Payer: United Healthcare All Payer |
$888.08
|
|
|
CATHFLO ACTIVASE 2MG VIAL
|
Facility
|
OP
|
$1,009.18
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$968.81 |
| Rate for Payer: Aetna Commercial |
$777.07
|
| Rate for Payer: Anthem Medicaid |
$347.06
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$94.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$787.16
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$131.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.10
|
| Rate for Payer: Cash Price |
$504.59
|
| Rate for Payer: Cash Price |
$504.59
|
| Rate for Payer: Cigna Commercial |
$837.62
|
| Rate for Payer: First Health Commercial |
$958.72
|
| Rate for Payer: Humana Commercial |
$857.80
|
| Rate for Payer: Humana KY Medicaid |
$347.06
|
| Rate for Payer: Humana Medicare Advantage |
$94.15
|
| Rate for Payer: Kentucky WC Medicaid |
$350.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$827.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$744.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$354.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$888.08
|
| Rate for Payer: Ohio Health Group HMO |
$756.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$877.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$696.33
|
| Rate for Payer: PHCS Commercial |
$968.81
|
| Rate for Payer: United Healthcare All Payer |
$888.08
|
|
|
CATHFLO/ALTEPLASE 1MG SOLN
|
Facility
|
IP
|
$352.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$105.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$281.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.88
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
CATHFLO/ALTEPLASE 1MG SOLN
|
Facility
|
OP
|
$352.00
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
25002372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$337.92 |
| Rate for Payer: Aetna Commercial |
$271.04
|
| Rate for Payer: Anthem Medicaid |
$121.05
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$94.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$274.56
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$131.81
|
| Rate for Payer: CareSource Just4Me Medicare |
$127.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna Commercial |
$292.16
|
| Rate for Payer: First Health Commercial |
$334.40
|
| Rate for Payer: Humana Commercial |
$299.20
|
| Rate for Payer: Humana KY Medicaid |
$121.05
|
| Rate for Payer: Humana Medicare Advantage |
$94.15
|
| Rate for Payer: Kentucky WC Medicaid |
$122.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$288.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$259.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$112.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$123.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$309.76
|
| Rate for Payer: Ohio Health Group HMO |
$264.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$281.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$306.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$242.88
|
| Rate for Payer: PHCS Commercial |
$337.92
|
| Rate for Payer: United Healthcare All Payer |
$309.76
|
|
|
CATH FOLEY 12FR 5CC
|
Facility
|
OP
|
$156.20
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$149.95 |
| Rate for Payer: Aetna Commercial |
$120.27
|
| Rate for Payer: Anthem Medicaid |
$53.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.84
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna Commercial |
$129.65
|
| Rate for Payer: First Health Commercial |
$148.39
|
| Rate for Payer: Humana Commercial |
$132.77
|
| Rate for Payer: Humana KY Medicaid |
$53.72
|
| Rate for Payer: Kentucky WC Medicaid |
$54.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.46
|
| Rate for Payer: Ohio Health Group HMO |
$117.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.78
|
| Rate for Payer: PHCS Commercial |
$149.95
|
| Rate for Payer: United Healthcare All Payer |
$137.46
|
|
|
CATH FOLEY 12FR 5CC
|
Facility
|
IP
|
$156.20
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27000036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$149.95 |
| Rate for Payer: Aetna Commercial |
$120.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$121.84
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna Commercial |
$129.65
|
| Rate for Payer: First Health Commercial |
$148.39
|
| Rate for Payer: Humana Commercial |
$132.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$128.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$115.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$46.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$137.46
|
| Rate for Payer: Ohio Health Group HMO |
$117.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$124.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$135.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$107.78
|
| Rate for Payer: PHCS Commercial |
$149.95
|
| Rate for Payer: United Healthcare All Payer |
$137.46
|
|
|
CATH GUIDING HOCKY STICK 8FR
|
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 GUIDING HOCKY STICK 8FR
|
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 GUIDING RENAL 8FR
|
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 GUIDING RENAL 8FR
|
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 GUIDING RENAL MULTI 8FR
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
CATH GUIDING RENAL MULTI 8FR
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
CATH GUIDING STRAIGHT 8FR
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
CATH GUIDING STRAIGHT 8FR
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
27000243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$1,366.75
|
| Rate for Payer: Anthem Medicaid |
$610.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.50
|
| Rate for Payer: Cash Price |
$887.50
|
| Rate for Payer: Cigna Commercial |
$1,473.25
|
| Rate for Payer: First Health Commercial |
$1,686.25
|
| Rate for Payer: Humana Commercial |
$1,508.75
|
| Rate for Payer: Humana KY Medicaid |
$610.42
|
| Rate for Payer: Kentucky WC Medicaid |
$616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,309.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.75
|
| Rate for Payer: PHCS Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare All Payer |
$1,562.00
|
|
|
CATH HICKMAN DIALYSIS 13.5FR
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem Medicaid |
$662.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Humana KY Medicaid |
$662.70
|
| Rate for Payer: Kentucky WC Medicaid |
$669.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
CATH HICKMAN DIALYSIS 13.5FR
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
27000039
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.10 |
| Max. Negotiated Rate |
$1,849.92 |
| Rate for Payer: Aetna Commercial |
$1,483.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Cash Price |
$963.50
|
| Rate for Payer: Cigna Commercial |
$1,599.41
|
| Rate for Payer: First Health Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,580.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,422.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$578.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,445.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,541.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,676.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.63
|
| Rate for Payer: PHCS Commercial |
$1,849.92
|
| Rate for Payer: United Healthcare All Payer |
$1,695.76
|
|
|
CATH IN 20G*1 1/4 ACUVANCE
|
Facility
|
OP
|
$31.27
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$30.02 |
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Anthem Medicaid |
$10.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.39
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cigna Commercial |
$25.95
|
| Rate for Payer: First Health Commercial |
$29.71
|
| Rate for Payer: Humana Commercial |
$26.58
|
| Rate for Payer: Humana KY Medicaid |
$10.75
|
| Rate for Payer: Kentucky WC Medicaid |
$10.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.52
|
| Rate for Payer: Ohio Health Group HMO |
$23.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.58
|
| Rate for Payer: PHCS Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Payer |
$27.52
|
|
|
CATH IN 20G*1 1/4 ACUVANCE
|
Facility
|
IP
|
$31.27
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$30.02 |
| Rate for Payer: Aetna Commercial |
$24.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.39
|
| Rate for Payer: Cash Price |
$15.63
|
| Rate for Payer: Cigna Commercial |
$25.95
|
| Rate for Payer: First Health Commercial |
$29.71
|
| Rate for Payer: Humana Commercial |
$26.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$25.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.52
|
| Rate for Payer: Ohio Health Group HMO |
$23.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.58
|
| Rate for Payer: PHCS Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Payer |
$27.52
|
|
|
CATH IN 24G*5/8 ACUVANCE
|
Facility
|
OP
|
$31.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Aetna Commercial |
$24.49
|
| Rate for Payer: Anthem Medicaid |
$10.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.80
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: First Health Commercial |
$30.21
|
| Rate for Payer: Humana Commercial |
$27.03
|
| Rate for Payer: Humana KY Medicaid |
$10.94
|
| Rate for Payer: Kentucky WC Medicaid |
$11.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.98
|
| Rate for Payer: Ohio Health Group HMO |
$23.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.94
|
| Rate for Payer: PHCS Commercial |
$30.53
|
| Rate for Payer: United Healthcare All Payer |
$27.98
|
|
|
CATH IN 24G*5/8 ACUVANCE
|
Facility
|
IP
|
$31.80
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Aetna Commercial |
$24.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.80
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$26.39
|
| Rate for Payer: First Health Commercial |
$30.21
|
| Rate for Payer: Humana Commercial |
$27.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$27.98
|
| Rate for Payer: Ohio Health Group HMO |
$23.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$21.94
|
| Rate for Payer: PHCS Commercial |
$30.53
|
| Rate for Payer: United Healthcare All Payer |
$27.98
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$13,050.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,487.90 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$10,048.50
|
| Rate for Payer: Anthem Medicaid |
$4,487.90
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,179.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$6,992.66
|
| Rate for Payer: CareSource Just4Me Medicare |
$6,742.93
|
| Rate for Payer: Cash Price |
$6,525.00
|
| Rate for Payer: Cash Price |
$6,525.00
|
| Rate for Payer: Cigna Commercial |
$10,831.50
|
| Rate for Payer: First Health Commercial |
$12,397.50
|
| Rate for Payer: Humana Commercial |
$11,092.50
|
| Rate for Payer: Humana KY Medicaid |
$4,487.90
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,533.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,701.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,630.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,577.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,484.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,787.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,353.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,004.50
|
| Rate for Payer: PHCS Commercial |
$12,528.00
|
| Rate for Payer: United Healthcare All Payer |
$11,484.00
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$11,999.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
761T1447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,599.85 |
| Max. Negotiated Rate |
$11,519.52 |
| Rate for Payer: Aetna Commercial |
$9,239.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,359.61
|
| Rate for Payer: Cash Price |
$5,999.75
|
| Rate for Payer: Cigna Commercial |
$9,959.58
|
| Rate for Payer: First Health Commercial |
$11,399.52
|
| Rate for Payer: Humana Commercial |
$10,199.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,839.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,855.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,599.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,559.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,999.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,599.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,439.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,279.66
|
| Rate for Payer: PHCS Commercial |
$11,519.52
|
| Rate for Payer: United Healthcare All Payer |
$10,559.56
|
|
