|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
36000040
|
|
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 INTERNAL CAROT UNILATERAL
|
Professional
|
Both
|
$15,499.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
76101447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.33 |
| Max. Negotiated Rate |
$9,299.70 |
| Rate for Payer: Ambetter Exchange |
$350.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.33
|
| Rate for Payer: Anthem Medicaid |
$1,318.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$350.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.12
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Healthspan PPO |
$2,021.52
|
| Rate for Payer: Humana Medicaid |
$1,318.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$350.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,345.28
|
| Rate for Payer: Molina Healthcare Passport |
$1,318.90
|
| Rate for Payer: Multiplan PHCS |
$9,299.70
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$456.21
|
| Rate for Payer: UHCCP Medicaid |
$211.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,332.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$350.93
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$12,609.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
36000040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,336.24 |
| Max. Negotiated Rate |
$12,104.64 |
| Rate for Payer: Aetna Commercial |
$9,708.93
|
| Rate for Payer: Anthem Medicaid |
$4,336.24
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,835.02
|
| 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 |
$6,304.50
|
| Rate for Payer: Cash Price |
$6,304.50
|
| Rate for Payer: Cigna Commercial |
$10,465.47
|
| Rate for Payer: First Health Commercial |
$11,978.55
|
| Rate for Payer: Humana Commercial |
$10,717.65
|
| Rate for Payer: Humana KY Medicaid |
$4,336.24
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,380.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,339.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,305.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,423.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,095.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,456.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$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 INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$11,999.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
761T1447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,126.63 |
| Max. Negotiated Rate |
$11,519.52 |
| Rate for Payer: Aetna Commercial |
$9,239.61
|
| Rate for Payer: Anthem Medicaid |
$4,126.63
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,359.61
|
| 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 |
$5,999.75
|
| 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: Humana KY Medicaid |
$4,126.63
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$4,168.63
|
| 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 |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,209.42
|
| 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
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$15,499.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
76101447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,649.85 |
| Max. Negotiated Rate |
$14,879.52 |
| Rate for Payer: Aetna Commercial |
$11,934.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,089.61
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cigna Commercial |
$12,864.58
|
| Rate for Payer: First Health Commercial |
$14,724.52
|
| Rate for Payer: Humana Commercial |
$13,174.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,709.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,438.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,649.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$11,624.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,399.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,484.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,694.66
|
| Rate for Payer: PHCS Commercial |
$14,879.52
|
| Rate for Payer: United Healthcare All Payer |
$13,639.56
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
OP
|
$15,499.50
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
76101447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$4,994.76 |
| Max. Negotiated Rate |
$14,879.52 |
| Rate for Payer: Aetna Commercial |
$11,934.61
|
| Rate for Payer: Anthem Medicaid |
$5,330.28
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$4,994.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,089.61
|
| 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 |
$7,749.75
|
| Rate for Payer: Cash Price |
$7,749.75
|
| Rate for Payer: Cigna Commercial |
$12,864.58
|
| Rate for Payer: First Health Commercial |
$14,724.52
|
| Rate for Payer: Humana Commercial |
$13,174.58
|
| Rate for Payer: Humana KY Medicaid |
$5,330.28
|
| Rate for Payer: Humana Medicare Advantage |
$4,994.76
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,709.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,438.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,993.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,639.56
|
| Rate for Payer: Ohio Health Group HMO |
$11,624.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,399.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,484.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,694.66
|
| Rate for Payer: PHCS Commercial |
$14,879.52
|
| Rate for Payer: United Healthcare All Payer |
$13,639.56
|
|
|
CATH INTERNAL CAROT UNILATERAL
|
Facility
|
IP
|
$13,050.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
48100018
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,915.00 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$10,048.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,179.00
|
| 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: 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 |
$3,915.00
|
| 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
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 36224
|
| Hospital Charge Code |
761P1447
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$201.33 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Ambetter Exchange |
$350.93
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$201.33
|
| Rate for Payer: Anthem Medicaid |
$1,318.90
|
| Rate for Payer: Buckeye Individual/Medicaid |
$350.93
|
| Rate for Payer: Buckeye Medicare Advantage |
$350.93
|
| Rate for Payer: CareSource Just4Me Medicare |
$421.12
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cash Price |
$1,750.00
|
| Rate for Payer: Cigna Commercial |
$642.97
|
| Rate for Payer: Healthspan PPO |
$2,021.52
|
| Rate for Payer: Humana Medicaid |
$1,318.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$435.52
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$350.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.93
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$1,345.28
|
| Rate for Payer: Molina Healthcare Passport |
$1,318.90
|
| Rate for Payer: Multiplan PHCS |
$2,100.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$456.21
|
| Rate for Payer: UHCCP Medicaid |
$211.40
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$1,332.09
|
| Rate for Payer: Wellcare Medicare Advantage |
$350.93
|
|
|
CATH LAB LEVEL 1 PER 15 MIN
|
Facility
|
OP
|
$1,279.00
|
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$383.70 |
| Max. Negotiated Rate |
$1,227.84 |
| Rate for Payer: Aetna Commercial |
$984.83
|
| Rate for Payer: Anthem Medicaid |
$439.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$997.62
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cigna Commercial |
$1,061.57
|
| Rate for Payer: First Health Commercial |
$1,215.05
|
| Rate for Payer: Humana Commercial |
$1,087.15
|
| Rate for Payer: Humana KY Medicaid |
$439.85
|
| Rate for Payer: Kentucky WC Medicaid |
$444.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,048.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$448.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,125.52
|
| Rate for Payer: Ohio Health Group HMO |
$959.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$882.51
|
| Rate for Payer: PHCS Commercial |
$1,227.84
|
| Rate for Payer: United Healthcare All Payer |
$1,125.52
|
|
|
CATH LAB LEVEL 1 PER 15 MIN
|
Facility
|
IP
|
$1,279.00
|
|
| Hospital Charge Code |
48100093
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$383.70 |
| Max. Negotiated Rate |
$1,227.84 |
| Rate for Payer: Aetna Commercial |
$984.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$997.62
|
| Rate for Payer: Cash Price |
$639.50
|
| Rate for Payer: Cigna Commercial |
$1,061.57
|
| Rate for Payer: First Health Commercial |
$1,215.05
|
| Rate for Payer: Humana Commercial |
$1,087.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,048.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$943.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$383.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,125.52
|
| Rate for Payer: Ohio Health Group HMO |
$959.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,112.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$882.51
|
| Rate for Payer: PHCS Commercial |
$1,227.84
|
| Rate for Payer: United Healthcare All Payer |
$1,125.52
|
|
|
CATH LAB LEVEL 2 PER 15 MIN
|
Facility
|
IP
|
$2,915.00
|
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.35
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
CATH LAB LEVEL 2 PER 15 MIN
|
Facility
|
OP
|
$2,915.00
|
|
| Hospital Charge Code |
48100094
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$874.50 |
| Max. Negotiated Rate |
$2,798.40 |
| Rate for Payer: Aetna Commercial |
$2,244.55
|
| Rate for Payer: Anthem Medicaid |
$1,002.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,457.50
|
| Rate for Payer: Cigna Commercial |
$2,419.45
|
| Rate for Payer: First Health Commercial |
$2,769.25
|
| Rate for Payer: Humana Commercial |
$2,477.75
|
| Rate for Payer: Humana KY Medicaid |
$1,002.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,012.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,390.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,151.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$874.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,022.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,565.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,186.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,332.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,536.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.35
|
| Rate for Payer: PHCS Commercial |
$2,798.40
|
| Rate for Payer: United Healthcare All Payer |
$2,565.20
|
|
|
CATH LAB LEVEL 3 PER 15 MIN
|
Facility
|
OP
|
$4,254.00
|
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,276.20 |
| Max. Negotiated Rate |
$4,083.84 |
| Rate for Payer: Aetna Commercial |
$3,275.58
|
| Rate for Payer: Anthem Medicaid |
$1,462.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.12
|
| Rate for Payer: Cash Price |
$2,127.00
|
| Rate for Payer: Cigna Commercial |
$3,530.82
|
| Rate for Payer: First Health Commercial |
$4,041.30
|
| Rate for Payer: Humana Commercial |
$3,615.90
|
| Rate for Payer: Humana KY Medicaid |
$1,462.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,477.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,700.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.26
|
| Rate for Payer: PHCS Commercial |
$4,083.84
|
| Rate for Payer: United Healthcare All Payer |
$3,743.52
|
|
|
CATH LAB LEVEL 3 PER 15 MIN
|
Facility
|
IP
|
$4,254.00
|
|
| Hospital Charge Code |
48100095
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,276.20 |
| Max. Negotiated Rate |
$4,083.84 |
| Rate for Payer: Aetna Commercial |
$3,275.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.12
|
| Rate for Payer: Cash Price |
$2,127.00
|
| Rate for Payer: Cigna Commercial |
$3,530.82
|
| Rate for Payer: First Health Commercial |
$4,041.30
|
| Rate for Payer: Humana Commercial |
$3,615.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,700.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.26
|
| Rate for Payer: PHCS Commercial |
$4,083.84
|
| Rate for Payer: United Healthcare All Payer |
$3,743.52
|
|
|
CATH LAB LEVEL 4 PER 15 MIN
|
Facility
|
OP
|
$4,542.00
|
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$4,360.32 |
| Rate for Payer: Aetna Commercial |
$3,497.34
|
| Rate for Payer: Anthem Medicaid |
$1,561.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,542.76
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,769.86
|
| Rate for Payer: First Health Commercial |
$4,314.90
|
| Rate for Payer: Humana Commercial |
$3,860.70
|
| Rate for Payer: Humana KY Medicaid |
$1,561.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,577.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,724.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,593.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,996.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,133.98
|
| Rate for Payer: PHCS Commercial |
$4,360.32
|
| Rate for Payer: United Healthcare All Payer |
$3,996.96
|
|
|
CATH LAB LEVEL 4 PER 15 MIN
|
Facility
|
IP
|
$4,542.00
|
|
| Hospital Charge Code |
48100096
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,362.60 |
| Max. Negotiated Rate |
$4,360.32 |
| Rate for Payer: Aetna Commercial |
$3,497.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,542.76
|
| Rate for Payer: Cash Price |
$2,271.00
|
| Rate for Payer: Cigna Commercial |
$3,769.86
|
| Rate for Payer: First Health Commercial |
$4,314.90
|
| Rate for Payer: Humana Commercial |
$3,860.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,724.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,352.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,362.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,996.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,406.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,633.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,951.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,133.98
|
| Rate for Payer: PHCS Commercial |
$4,360.32
|
| Rate for Payer: United Healthcare All Payer |
$3,996.96
|
|
|
CATH LAB LEVEL 5 PER 15 MIN
|
Facility
|
OP
|
$7,310.00
|
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,193.00 |
| Max. Negotiated Rate |
$7,017.60 |
| Rate for Payer: Aetna Commercial |
$5,628.70
|
| Rate for Payer: Anthem Medicaid |
$2,513.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,701.80
|
| Rate for Payer: Cash Price |
$3,655.00
|
| Rate for Payer: Cigna Commercial |
$6,067.30
|
| Rate for Payer: First Health Commercial |
$6,944.50
|
| Rate for Payer: Humana Commercial |
$6,213.50
|
| Rate for Payer: Humana KY Medicaid |
$2,513.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,539.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,994.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,394.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,193.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,564.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,432.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,482.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,359.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,043.90
|
| Rate for Payer: PHCS Commercial |
$7,017.60
|
| Rate for Payer: United Healthcare All Payer |
$6,432.80
|
|
|
CATH LAB LEVEL 5 PER 15 MIN
|
Facility
|
IP
|
$7,310.00
|
|
| Hospital Charge Code |
48100097
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,193.00 |
| Max. Negotiated Rate |
$7,017.60 |
| Rate for Payer: Aetna Commercial |
$5,628.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,701.80
|
| Rate for Payer: Cash Price |
$3,655.00
|
| Rate for Payer: Cigna Commercial |
$6,067.30
|
| Rate for Payer: First Health Commercial |
$6,944.50
|
| Rate for Payer: Humana Commercial |
$6,213.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,994.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,394.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,193.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,432.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,482.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,359.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,043.90
|
| Rate for Payer: PHCS Commercial |
$7,017.60
|
| Rate for Payer: United Healthcare All Payer |
$6,432.80
|
|
|
CATH MAHURKAR 12*16
|
Facility
|
OP
|
$1,752.39
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.72 |
| Max. Negotiated Rate |
$1,682.29 |
| Rate for Payer: Aetna Commercial |
$1,349.34
|
| Rate for Payer: Anthem Medicaid |
$602.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.86
|
| Rate for Payer: Cash Price |
$876.20
|
| Rate for Payer: Cigna Commercial |
$1,454.48
|
| Rate for Payer: First Health Commercial |
$1,664.77
|
| Rate for Payer: Humana Commercial |
$1,489.53
|
| Rate for Payer: Humana KY Medicaid |
$602.65
|
| Rate for Payer: Kentucky WC Medicaid |
$608.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.15
|
| Rate for Payer: PHCS Commercial |
$1,682.29
|
| Rate for Payer: United Healthcare All Payer |
$1,542.10
|
|
|
CATH MAHURKAR 12*16
|
Facility
|
IP
|
$1,752.39
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.72 |
| Max. Negotiated Rate |
$1,682.29 |
| Rate for Payer: Aetna Commercial |
$1,349.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,366.86
|
| Rate for Payer: Cash Price |
$876.20
|
| Rate for Payer: Cigna Commercial |
$1,454.48
|
| Rate for Payer: First Health Commercial |
$1,664.77
|
| Rate for Payer: Humana Commercial |
$1,489.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,436.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,293.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,542.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,314.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,524.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.15
|
| Rate for Payer: PHCS Commercial |
$1,682.29
|
| Rate for Payer: United Healthcare All Payer |
$1,542.10
|
|
|
CATH MAHURKAR 13.5*19.5
|
Facility
|
OP
|
$1,850.70
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.21 |
| Max. Negotiated Rate |
$1,776.67 |
| Rate for Payer: Aetna Commercial |
$1,425.04
|
| Rate for Payer: Anthem Medicaid |
$636.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.55
|
| Rate for Payer: Cash Price |
$925.35
|
| Rate for Payer: Cigna Commercial |
$1,536.08
|
| Rate for Payer: First Health Commercial |
$1,758.16
|
| Rate for Payer: Humana Commercial |
$1,573.10
|
| Rate for Payer: Humana KY Medicaid |
$636.46
|
| Rate for Payer: Kentucky WC Medicaid |
$642.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.98
|
| Rate for Payer: PHCS Commercial |
$1,776.67
|
| Rate for Payer: United Healthcare All Payer |
$1,628.62
|
|
|
CATH MAHURKAR 13.5*19.5
|
Facility
|
IP
|
$1,850.70
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.21 |
| Max. Negotiated Rate |
$1,776.67 |
| Rate for Payer: Aetna Commercial |
$1,425.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.55
|
| Rate for Payer: Cash Price |
$925.35
|
| Rate for Payer: Cigna Commercial |
$1,536.08
|
| Rate for Payer: First Health Commercial |
$1,758.16
|
| Rate for Payer: Humana Commercial |
$1,573.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,365.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,276.98
|
| Rate for Payer: PHCS Commercial |
$1,776.67
|
| Rate for Payer: United Healthcare All Payer |
$1,628.62
|
|
|
CATH MAHURKAR DUAL13.5*16
|
Facility
|
IP
|
$1,739.21
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.76 |
| Max. Negotiated Rate |
$1,669.64 |
| Rate for Payer: Aetna Commercial |
$1,339.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.58
|
| Rate for Payer: Cash Price |
$869.61
|
| Rate for Payer: Cigna Commercial |
$1,443.54
|
| Rate for Payer: First Health Commercial |
$1,652.25
|
| Rate for Payer: Humana Commercial |
$1,478.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,513.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.05
|
| Rate for Payer: PHCS Commercial |
$1,669.64
|
| Rate for Payer: United Healthcare All Payer |
$1,530.50
|
|
|
CATH MAHURKAR DUAL13.5*16
|
Facility
|
OP
|
$1,739.21
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$521.76 |
| Max. Negotiated Rate |
$1,669.64 |
| Rate for Payer: Aetna Commercial |
$1,339.19
|
| Rate for Payer: Anthem Medicaid |
$598.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.58
|
| Rate for Payer: Cash Price |
$869.61
|
| Rate for Payer: Cigna Commercial |
$1,443.54
|
| Rate for Payer: First Health Commercial |
$1,652.25
|
| Rate for Payer: Humana Commercial |
$1,478.33
|
| Rate for Payer: Humana KY Medicaid |
$598.11
|
| Rate for Payer: Kentucky WC Medicaid |
$604.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,391.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,513.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,200.05
|
| Rate for Payer: PHCS Commercial |
$1,669.64
|
| Rate for Payer: United Healthcare All Payer |
$1,530.50
|
|
|
CATH MAHURKAR TRIPLE 12*20
|
Facility
|
OP
|
$7,868.88
|
|
|
Service Code
|
HCPCS C1752
|
| Hospital Charge Code |
27000041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,360.66 |
| Max. Negotiated Rate |
$7,554.12 |
| Rate for Payer: Aetna Commercial |
$6,059.04
|
| Rate for Payer: Anthem Medicaid |
$2,706.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,137.73
|
| Rate for Payer: Cash Price |
$3,934.44
|
| Rate for Payer: Cigna Commercial |
$6,531.17
|
| Rate for Payer: First Health Commercial |
$7,475.44
|
| Rate for Payer: Humana Commercial |
$6,688.55
|
| Rate for Payer: Humana KY Medicaid |
$2,706.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,733.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,452.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,807.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,760.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,924.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,901.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,295.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,845.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,429.53
|
| Rate for Payer: PHCS Commercial |
$7,554.12
|
| Rate for Payer: United Healthcare All Payer |
$6,924.61
|
|
